Healthcare Provider Details

I. General information

NPI: 1619234176
Provider Name (Legal Business Name): THE BURN SURGEONS OF ACADIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2012
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

200 BEAULLIEU DR BLDG 3B
LAFAYETTE LA
70508-7230
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-4279
  • Fax: 337-470-4268
Mailing address:
  • Phone: 337-261-9004
  • Fax: 337-261-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVE JOSEPH BARRIOS III
Title or Position: DIRECTOR
Credential: M.D.
Phone: 337-261-9004