Healthcare Provider Details

I. General information

NPI: 1134562523
Provider Name (Legal Business Name): PHILIPPE EDOUARD PROUET II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 COOLIDGE BLVD STE 100
LAFAYETTE LA
70503-2638
US

IV. Provider business mailing address

324 DULLES DR
LAFAYETTE LA
70506-3008
US

V. Phone/Fax

Practice location:
  • Phone: 337-289-8400
  • Fax: 337-289-8401
Mailing address:
  • Phone: 337-706-1582
  • Fax: 337-261-2697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number312641
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: