Provider Demographics
NPI:1982650503
Name:HAROLD G BIENVENU III MD, APMC
Entity Type:Organization
Organization Name:HAROLD G BIENVENU III MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BIENVENU
Authorized Official - Suffix:III
Authorized Official - Credentials:MD,APMC
Authorized Official - Phone:337-439-2040
Mailing Address - Street 1:711 DR MICHAEL DEBAKEY DRIVE
Mailing Address - Street 2:STE # 100
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5785
Mailing Address - Country:US
Mailing Address - Phone:337-439-2040
Mailing Address - Fax:337-439-2042
Practice Address - Street 1:711 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:STE # 100
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5785
Practice Address - Country:US
Practice Address - Phone:337-439-2040
Practice Address - Fax:337-439-2042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015116207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA015116OtherSTATE LICENSE
LAB61455Medicare UPIN