Healthcare Provider Details

I. General information

NPI: 1457557977
Provider Name (Legal Business Name): LAFAYETTE PEDIATRIC NEUROLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 AMBASSADOR CAFFERY PKWY SUITE 103
LAFAYETTE LA
70508-6926
US

IV. Provider business mailing address

4650 AMBASSADOR CAFFERY PKWY SUITE 103
LAFAYETTE LA
70508-6926
US

V. Phone/Fax

Practice location:
  • Phone: 337-993-7391
  • Fax:
Mailing address:
  • Phone: 337-993-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateLA

VIII. Authorized Official

Name: ROBERT J LAGESSE
Title or Position: VICE PRESIDENT
Credential:
Phone: 504-988-7044