Provider Demographics
NPI:1710289970
Name:ANDREW F. CLARKE, LLC
Entity Type:Organization
Organization Name:ANDREW F. CLARKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:F
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-364-7700
Mailing Address - Street 1:1100 ANDRE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2159
Mailing Address - Country:US
Mailing Address - Phone:337-364-7700
Mailing Address - Fax:337-364-0005
Practice Address - Street 1:1100 ANDRE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-364-7700
Practice Address - Fax:337-364-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA022576207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4F231Medicare PIN