Healthcare Provider Details

I. General information

NPI: 1316872708
Provider Name (Legal Business Name): ERIC ALLEN AUSTIN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BERTRAND DR
LAFAYETTE LA
70506-4110
US

IV. Provider business mailing address

115 JALON RD
SCOTT LA
70583-4815
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-8500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: