Healthcare Provider Details

I. General information

NPI: 1093915894
Provider Name (Legal Business Name): PHILIP S PERRET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 07/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W SAINT MARY BLVD
LAFAYETTE LA
70506-3538
US

IV. Provider business mailing address

614 W SAINT MARY BLVD
LAFAYETTE LA
70506-3538
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-6435
  • Fax: 337-232-0152
Mailing address:
  • Phone: 337-232-6435
  • Fax: 337-232-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number4507R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: