| Victor Theriault Md | |
|
712 Willis Ave Bogalusa LA 70427-3004 | |
| (985) 732-4853 | |
| Not Available |
| Full Name | Victor Theriault Md |
|---|---|
| Speciality | Family Medicine |
| Location | 712 Willis Ave, Bogalusa, Louisiana |
| Authorized Official Name and Position | Victor Theriault (PRESIDENT) |
| Authorized Official Contact | 9857324853 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Victor Theriault Md 712 Willis Ave Bogalusa LA 70427-3004 Ph: (985) 732-4853 | Victor Theriault Md 712 Willis Ave Bogalusa LA 70427-3004 Ph: (985) 732-4853 |
| NPI Number | 1164500906 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164500906 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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