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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 |
