Healthcare Provider Details

I. General information

NPI: 1386631109
Provider Name (Legal Business Name): ROLAND J. DEGEYTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 11/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 HAIFLEIGH ST
FRANKLIN LA
70538-3854
US

IV. Provider business mailing address

502 HAIFLEIGH ST
FRANKLIN LA
70538-3854
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-5151
  • Fax:
Mailing address:
  • Phone: 337-261-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number013214
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: