Provider Demographics
NPI:1528239555
Name:RICHARD J. BIDSTRUP, M.D. LTD.
Entity type:Organization
Organization Name:RICHARD J. BIDSTRUP, M.D. LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BIDSTRUP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-942-2674
Mailing Address - Street 1:4049 I 49 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0757
Mailing Address - Country:US
Mailing Address - Phone:337-942-2674
Mailing Address - Fax:337-948-1858
Practice Address - Street 1:4049 I 49 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0757
Practice Address - Country:US
Practice Address - Phone:337-942-2674
Practice Address - Fax:337-948-1858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL009234207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4354896360OtherBLUE CROSS BLUE SHIELD LA
LA1153834Medicaid
LA1153834Medicaid