Healthcare Provider Details

I. General information

NPI: 1447757067
Provider Name (Legal Business Name): WILLIAM ROGER ISHEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 KALISTE SALOOM RD STE 300
LAFAYETTE LA
70508-5784
US

IV. Provider business mailing address

407 KIM DR
LAFAYETTE LA
70503-4023
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-3282
  • Fax: 337-456-3491
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number336354
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: