Healthcare Provider Details

I. General information

NPI: 1538599592
Provider Name (Legal Business Name): FAMILY DOCTOR CLINIC OF LAPLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 W AIRLINE HWY SUITE B
LA PLACE LA
70068-3817
US

IV. Provider business mailing address

429 W AIRLINE HWY SUITE B
LA PLACE LA
70068-3817
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-3344
  • Fax: 985-652-9320
Mailing address:
  • Phone: 985-652-3344
  • Fax: 985-652-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN MONTEGUT
Title or Position: MEMBER
Credential: MD
Phone: 985-652-3344