Provider Demographics
NPI:1528379351
Name:SEGURA FAMILY MEDICINE
Entity Type:Organization
Organization Name:SEGURA FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SEGURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-654-0871
Mailing Address - Street 1:1636 ELTON RD STE 204
Mailing Address - Street 2:
Mailing Address - City:JENNINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70546-3648
Mailing Address - Country:US
Mailing Address - Phone:337-654-0871
Mailing Address - Fax:337-896-8324
Practice Address - Street 1:1636 ELTON RD STE 204
Practice Address - Street 2:
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3648
Practice Address - Country:US
Practice Address - Phone:337-654-0871
Practice Address - Fax:337-896-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-26
Last Update Date:2010-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202491207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty