L Glen Mire MD Inc

Primary specialty

Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X

License

012202 Issued in LA

Legal business name

L GLEN MIRE MD INC

Practice address

324 Dulles Dr
Lafayette, LA 70506-3008

Phone

(337) 981-0305

NPI assigned

Jul 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Louis Glen Mire, MD

Title

Owner

Phone

(337) 981-0305

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1134328966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 61950",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705961950",
            "telephone_number": "337-981-0305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 DULLES DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705063008",
            "telephone_number": "337-981-0305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L GLEN MIRE MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-12",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "MIRE",
        "authorized_official_first_name": "LOUIS",
        "authorized_official_middle_name": "GLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "337-981-0305",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "LA",
            "license": "012202",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1197386",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Family Medicine) Physician in Lafayette, LA
• Providers in Lafayette, LA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.