Healthcare Provider Details

I. General information

NPI: 1699781591
Provider Name (Legal Business Name): BRIAN D MONETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E ASCENSION COMPLEX AVE.
GONZALES LA
70737
US

IV. Provider business mailing address

P.O. BOX 1725
GONZALES LA
70107-1725
US

V. Phone/Fax

Practice location:
  • Phone: 225-921-5770
  • Fax: 225-644-5168
Mailing address:
  • Phone: 225-621-5770
  • Fax: 225-644-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberR019642 / L023786
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR019642 / L023786
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberR019642 / L023786
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number023786
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: