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Mr. Kirby George Desormeaux

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NPI Number Detailed Information

Provider Information:

Name: Mr. Kirby George Desormeaux
Gender: M
Provider License Number If Given: 9239

NPI Information:

NPI: 1124021159
Entity Type
(Individual or Organization):
1-ind
Enumeration Date: 5/23/2005

Last Update Date: 7/8/2007

Provider Business Mailing Address:

Address: 1305 WINDSOR PL
Alexandria, LA 71303
Phone Number: 3184452575
Fax Number: 3184849457

Provider Business Practice Location Address:

Address: 1305 WINDSOR PL
Alexandria, LA 71303
Phone Number: 3184452575
Fax Number: 3184849457

Provider Taxonomy:

Primary: 183500000X
Secondary (if any):
State: LA

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