Provider Demographics
NPI:1750366027
Name:BEVELS, GREGORY STEFAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:STEFAN
Last Name:BEVELS
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 1:3802 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3731
Mailing Address - Country:US
Mailing Address - Phone:318-487-6060
Mailing Address - Fax:318-880-0359
Practice Address - Street 1:3802 PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3731
Practice Address - Country:US
Practice Address - Phone:318-487-6060
Practice Address - Fax:318-880-0359
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1577910Medicaid
4E299Medicare ID - Type Unspecified
LA1577910Medicaid