Provider Demographics
NPI:1740612712
Name:MINUTE MED CLINIC-VEROT LLC
Entity Type:Organization
Organization Name:MINUTE MED CLINIC-VEROT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOUDREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MDQ
Authorized Official - Phone:337-412-6650
Mailing Address - Street 1:626 VEROT SCHOOL RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5094
Mailing Address - Country:US
Mailing Address - Phone:337-412-6650
Mailing Address - Fax:
Practice Address - Street 1:626 VEROT SCHOOL RD
Practice Address - Street 2:SUITE F
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5094
Practice Address - Country:US
Practice Address - Phone:337-412-6650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty