Healthcare Provider Details

I. General information

NPI: 1336133008
Provider Name (Legal Business Name): WAYBRUN J HEBERT III DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 W TUNNEL BLVD STE. B
HOUMA LA
70360-4049
US

IV. Provider business mailing address

1025 W TUNNEL BLVD STE. B
HOUMA LA
70360-4049
US

V. Phone/Fax

Practice location:
  • Phone: 985-868-2973
  • Fax: 985-879-3116
Mailing address:
  • Phone: 985-868-2973
  • Fax: 985-879-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPD184R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: