Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.

Executive Medical Clinic of Lake Charles

Organization Family Medicine Physician · NPI 1982126520

Executive Medical Clinic of Lake Charles provides Family Medicine Physician services in Lake Charles, Louisiana. Licensed in Louisiana. Registered with an NPI since 2017.

Licensed in
LA
In the registry since
2017

Practice location Address checks out

765 E Bayou Pines Dr
Lake Charles, LA 70601-5690
Phone: (337) 210-1260
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence AP06496 (LA)

Record details

NPI number1982126520
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Melissa Lebrun — President · (225) 939-0050
NPI enumeratedJuly 14, 2017
Last updated in NPPESSeptember 19, 2022
Certification dateSeptember 14, 2022
Mailing address765 East Bayou Pines Drive, Lake Charles, LA 70601-5690

Other providers in Lake Charles