Healthcare Provider Details

I. General information

NPI: 1053607770
Provider Name (Legal Business Name): LOUISIANA IVF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E FARREL RD
LAFAYETTE LA
70508-7104
US

IV. Provider business mailing address

206 E FARREL RD
LAFAYETTE LA
70508-7104
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-8795
  • Fax: 337-989-8766
Mailing address:
  • Phone: 337-989-8795
  • Fax: 337-989-8766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number000251
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number021643
License Number StateLA

VIII. Authorized Official

Name: DEBORAH D DUGAS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 337-989-8795