Healthcare Provider Details

I. General information

NPI: 1952840522
Provider Name (Legal Business Name): JASON FAUCHEUX D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 MEADOWBROOK BLVD
MANDEVILLE LA
70471-7400
US

IV. Provider business mailing address

1170 MEADOWBROOK BLVD
MANDEVILLE LA
70471-7400
US

V. Phone/Fax

Practice location:
  • Phone: 985-705-1238
  • Fax: 945-529-4675
Mailing address:
  • Phone: 985-705-1238
  • Fax: 945-529-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number339491
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: