MEDICARE: MR. TROY JAMES PREVOT PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA.A10161.RX	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962437970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TROY JAMES PREVOT PA

Provider Business Mailing Address
First Line	:	242 SHADY LAKE PL W
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-4332
Country	:	US
Telephone Number	:	225-274-6760
Fax Number	:	225-216-4299

Provider Business Practice Location Address
First Line	:	2351 ENERGY DR
Second Line	:	SUITE 2000
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-2618
Country	:	US
Telephone Number	:	225-274-6760
Fax Number	:	225-216-4299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	06/17/2012

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