Healthcare Provider Details

I. General information

NPI: 1659363844
Provider Name (Legal Business Name): LASER & SURGERY CENTER OF ACADIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 SAINT LANDRY ST
LAFAYETTE LA
70506-4626
US

IV. Provider business mailing address

514 SAINT LANDRY ST
LAFAYETTE LA
70506-4626
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-2020
  • Fax: 337-234-8230
Mailing address:
  • Phone: 337-234-2020
  • Fax: 337-234-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PAUL JAMES AZAR
Title or Position: PRESIDENT
Credential: MD
Phone: 337-234-2020