Provider Demographics
NPI:1497780068
Name:ST. CLERGY, ROSEMARY (MD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:ST. CLERGY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6143
Mailing Address - Country:US
Mailing Address - Phone:337-981-5085
Mailing Address - Fax:337-881-5466
Practice Address - Street 1:2130 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6143
Practice Address - Country:US
Practice Address - Phone:337-981-5085
Practice Address - Fax:337-881-5466
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355569Medicaid
LAP00972527OtherMEDICARE RR
LAB64345Medicare UPIN
LA1355569Medicaid