Healthcare Provider Details

I. General information

NPI: 1427584341
Provider Name (Legal Business Name): LOGAN LEDET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 06/10/2024
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 MAIN ST
HOUMA LA
70360-3403
US

IV. Provider business mailing address

PO BOX 6014
HOUMA LA
70361-6014
US

V. Phone/Fax

Practice location:
  • Phone: 985-873-3484
  • Fax: 985-873-3495
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number336903
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: