1710078613 NPI number — DR. CLAIRE JEAN PURDOME LUELF M.D.

Table of content: DR. CLAIRE JEAN PURDOME LUELF M.D. (NPI 1710078613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710078613 NPI number — DR. CLAIRE JEAN PURDOME LUELF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUELF
Provider First Name:
CLAIRE
Provider Middle Name:
JEAN PURDOME
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710078613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1145
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIOGA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71477-1145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-612-7872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2495 SHREVEPORT; HIGHWAY 71 NORTH
Provider Second Line Business Practice Location Address:
VA MEDICAL CENTER - ALEXANDRIA
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-473-0010
Provider Business Practice Location Address Fax Number:
318-483-5036
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  E-3230 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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