Healthcare Provider Details

I. General information

NPI: 1205032448
Provider Name (Legal Business Name): LAFAYETTE PODIATRY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 BONAIRE DR
LAFAYETTE LA
70506-6827
US

IV. Provider business mailing address

205 BONAIRE DR
LAFAYETTE LA
70506-6827
US

V. Phone/Fax

Practice location:
  • Phone: 504-889-0347
  • Fax: 504-779-9741
Mailing address:
  • Phone: 504-889-0347
  • Fax: 504-779-9741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SCOTT M BEARSTO
Title or Position: OWNER
Credential: DPM
Phone: 504-889-0347