Healthcare Provider Details

I. General information

NPI: 1669229647
Provider Name (Legal Business Name): DWAYNE J BERGEAUX MD NEPHROLOGY & HYPERTENSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 WRIGHT AVE STE B
CROWLEY LA
70526-2226
US

IV. Provider business mailing address

1325 WRIGHT AVE STE B
CROWLEY LA
70526-2226
US

V. Phone/Fax

Practice location:
  • Phone: 337-788-2864
  • Fax: 337-788-2866
Mailing address:
  • Phone: 337-788-2864
  • Fax: 337-788-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY BERGEAUX
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-788-2864