Provider Demographics
NPI:1770575177
Name:BELLAH, LLOYD DEWAYNE (MD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:DEWAYNE
Last Name:BELLAH
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 1:1801 FAIRFIELD AVE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4468
Mailing Address - Country:US
Mailing Address - Phone:318-841-2801
Mailing Address - Fax:318-841-2800
Practice Address - Street 1:1801 FAIRFIELD AVE
Practice Address - Street 2:SUITE 409
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4443
Practice Address - Country:US
Practice Address - Phone:318-841-2801
Practice Address - Fax:318-841-2801
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12606R2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1539384Medicaid
LA5A404Medicare ID - Type UnspecifiedMEDICARE
TXTXB144223Medicare PIN
LA1539384Medicaid