Healthcare Provider Details

I. General information

NPI: 1528014586
Provider Name (Legal Business Name): LUIZ C DEARAUJO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 HOSPITAL DR SUITE A
LAFAYETTE LA
70503-2819
US

IV. Provider business mailing address

116 HOSPITAL DR SUITE A
LAFAYETTE LA
70503-2819
US

V. Phone/Fax

Practice location:
  • Phone: 337-269-6004
  • Fax: 337-261-9003
Mailing address:
  • Phone: 337-269-6004
  • Fax: 337-261-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number06212R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: