Provider Demographics
NPI:1659302586
Name:BELLANGER, DRAKE ERIC (MD)
Entity Type:Individual
Prefix:
First Name:DRAKE
Middle Name:ERIC
Last Name:BELLANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RUE DE LA VIE ST STE 513
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-5129
Mailing Address - Country:US
Mailing Address - Phone:225-924-8947
Mailing Address - Fax:225-924-8948
Practice Address - Street 1:500 RUE DE LA VIE ST STE 513
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817
Practice Address - Country:US
Practice Address - Phone:225-924-8947
Practice Address - Fax:225-924-8948
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11666R208600000X
AL00017404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1697486Medicaid
5Y431Medicare ID - Type Unspecified
LA1697486Medicaid