Healthcare Provider Details

I. General information

NPI: 1770417453
Provider Name (Legal Business Name): BARRETT MARK COON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PINE ST STE B
LAFAYETTE LA
70501-2913
US

IV. Provider business mailing address

500B RICHLAND AVE
LAFAYETTE LA
70508-6615
US

V. Phone/Fax

Practice location:
  • Phone: 337-202-8218
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7829
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: