Provider Demographics
NPI:1780697227
Name:CALHOUN, BRIAN KEITH (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KEITH
Last Name:CALHOUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 OLD STERLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2396
Mailing Address - Country:US
Mailing Address - Phone:318-324-1414
Mailing Address - Fax:318-324-2120
Practice Address - Street 1:4400 OLD STERLINGTON RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2396
Practice Address - Country:US
Practice Address - Phone:318-324-1414
Practice Address - Fax:318-324-2120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH17410Medicare UPIN
LA5H872Medicare ID - Type Unspecified