Healthcare Provider Details

I. General information

NPI: 1629042312
Provider Name (Legal Business Name): RYAN PAUL ARMENTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 01/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 AMBASSADOR CAFFERY PKWY
LAFAYETTE LA
70508-6917
US

IV. Provider business mailing address

PO BOX 54422
NEW ORLEANS LA
70154-4422
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-2195
  • Fax: 337-470-4590
Mailing address:
  • Phone: 337-470-2195
  • Fax: 337-470-2019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.200045
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200045.RX
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: