Healthcare Provider Details

I. General information

NPI: 1588740112
Provider Name (Legal Business Name): SUSAN F PUYAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 RUE DE LA VIE ST SUITE 310
BATON ROUGE LA
70817-5126
US

IV. Provider business mailing address

500 RUE DE LA VIE ST SUITE 310
BATON ROUGE LA
70817-5126
US

V. Phone/Fax

Practice location:
  • Phone: 225-201-0505
  • Fax: 225-935-2190
Mailing address:
  • Phone: 225-201-0505
  • Fax: 225-935-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD.018820
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number018820
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: