Healthcare Provider Details

I. General information

NPI: 1639276850
Provider Name (Legal Business Name): ACADIANA MATERNAL FETAL MEDICINE APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 AMBASSADOR CAFFERY PKWY STE 204
LAFAYETTE LA
70508-6949
US

IV. Provider business mailing address

4630 AMBASSADOR CAFFERY PKWY STE 204
LAFAYETTE LA
70508-6949
US

V. Phone/Fax

Practice location:
  • Phone: 337-989-9826
  • Fax: 337-989-9829
Mailing address:
  • Phone: 337-989-9826
  • Fax: 337-989-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PERRY S BARRILLEAUX
Title or Position: FIRST DIRECTOR
Credential: MD
Phone: 337-989-9826