Provider Demographics
NPI:1841482445
Name:BEEHARILAL, PERMANAND S J (MD)
Entity type:Individual
Prefix:DR
First Name:PERMANAND
Middle Name:S J
Last Name:BEEHARILAL
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 1:4242 HIGHWAY 19 STE A
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-3982
Mailing Address - Country:US
Mailing Address - Phone:225-286-4360
Mailing Address - Fax:225-286-4363
Practice Address - Street 1:4242 HIGHWAY 19 STE A
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-286-4360
Practice Address - Fax:225-286-4363
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203580261Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD203580OtherSTATE LICENSE
LA106817OtherMEDICARE
LA1822621Medicaid
LA1822621Medicaid