Healthcare Provider Details

I. General information

NPI: 1629024609
Provider Name (Legal Business Name): ROLAND J. DEGEYTER MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/08/2009
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: 337-828-7240
  • Fax: 337-828-1491
Mailing address:
  • Phone: 337-828-7240
  • Fax: 337-828-1491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KELLY H. DUPLANTIS
Title or Position: CONTRACTS & CREDENTIALING
Credential:
Phone: 337-706-1529