Healthcare Provider Details

I. General information

NPI: 1093970642
Provider Name (Legal Business Name): CHRISTIAN LYLE MONTEGUT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 WEST AIRLINE HWY SUITE B
LAPLACE LA
70068-3817
US

IV. Provider business mailing address

429 WEST AIRLINE HWY SUITE B
LAPLACE LA
70068-3817
US

V. Phone/Fax

Practice location:
  • Phone: 985-652-3344
  • Fax: 985-652-9320
Mailing address:
  • Phone: 985-652-3344
  • Fax: 985-652-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number203596
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: