Provider Demographics
NPI:1821067570
Name:NESOM, HERBERT ALDON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:ALDON
Last Name:NESOM
Suffix:JR
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:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:LA
Mailing Address - Zip Code:71463-1140
Mailing Address - Country:US
Mailing Address - Phone:318-335-4881
Mailing Address - Fax:318-335-4544
Practice Address - Street 1:400 E 6TH AVE
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:LA
Practice Address - Zip Code:71463-2628
Practice Address - Country:US
Practice Address - Phone:318-335-4881
Practice Address - Fax:318-335-4544
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1053970Medicaid
LA1053970Medicaid
LAB61074Medicare UPIN