Provider Demographics
NPI:1295722122
Name:BARES, GEORGE JUDE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:JUDE
Last Name:BARES
Suffix:
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 81885
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-1885
Mailing Address - Country:US
Mailing Address - Phone:337-988-2345
Mailing Address - Fax:
Practice Address - Street 1:4650 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6926
Practice Address - Country:US
Practice Address - Phone:337-988-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA21078208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1662917Medicaid
LA1662917Medicaid
LA5W319Medicare PIN