Healthcare Provider Details

I. General information

NPI: 1770581811
Provider Name (Legal Business Name): BRADLEY J CHASTANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W PINHOOK RD STE 201
LAFAYETTE LA
70503-2464
US

IV. Provider business mailing address

1000 W PINHOOK RD STE 201
LAFAYETTE LA
70503-2464
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-0650
  • Fax: 888-990-2781
Mailing address:
  • Phone: 337-237-0650
  • Fax: 888-990-2781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberL017239
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberL017239
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: