Provider Demographics
NPI:1669572947
Name:JUNEAU, BENJI (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MR
First Name:BENJI
Middle Name:
Last Name:JUNEAU
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 JOHN CIR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4508
Mailing Address - Country:US
Mailing Address - Phone:318-323-5446
Mailing Address - Fax:
Practice Address - Street 1:1910 JOHN CIR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4508
Practice Address - Country:US
Practice Address - Phone:318-323-5446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200086363A00000X
LA163481835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant