Healthcare Provider Details

I. General information

NPI: 1891931358
Provider Name (Legal Business Name): ACADIANA WEIGHT LOSS SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 01/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W PINHOOK RD SUITE 204
LAFAYETTE LA
70503-2460
US

IV. Provider business mailing address

1000 W PINHOOK RD SUITE 204
LAFAYETTE LA
70503-2460
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-9900
  • Fax: 337-233-0770
Mailing address:
  • Phone: 337-233-9900
  • Fax: 337-233-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEE DEE DUHON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 337-233-9900