Provider Demographics
NPI:1972147387
Name:ENT AND ALLERGY CLINIC LLC
Entity type:Organization
Organization Name:ENT AND ALLERGY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-312-4355
Mailing Address - Street 1:1615 WOLF CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2348
Mailing Address - Country:US
Mailing Address - Phone:337-312-8681
Mailing Address - Fax:337-312-8682
Practice Address - Street 1:1615 WOLF CIR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2348
Practice Address - Country:US
Practice Address - Phone:337-312-8681
Practice Address - Fax:337-312-8682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty