Healthcare Provider Details

I. General information

NPI: 1821034778
Provider Name (Legal Business Name): ALFONSO LEBRON-BERGES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-5906
US

IV. Provider business mailing address

2804 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70506-5906
US

V. Phone/Fax

Practice location:
  • Phone: 337-981-5156
  • Fax: 337-981-0673
Mailing address:
  • Phone: 337-981-5156
  • Fax: 337-981-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number09451R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: