Provider Demographics
NPI:1841611092
Name:BEAUREGARD FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:BEAUREGARD FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DOBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-463-3387
Mailing Address - Street 1:325 W 8TH ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-5505
Mailing Address - Country:US
Mailing Address - Phone:337-463-3387
Mailing Address - Fax:949-862-5301
Practice Address - Street 1:325 W 8TH ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-5505
Practice Address - Country:US
Practice Address - Phone:337-463-3387
Practice Address - Fax:949-862-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2342533Medicaid