Healthcare Provider Details

I. General information

NPI: 1669448825
Provider Name (Legal Business Name): STEPHEN M LAYNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOUMA BLVD SUITE 380
METAIRIE LA
70006-2933
US

IV. Provider business mailing address

4224 HOUMA BLVD SUITE 380
METAIRIE LA
70006-2933
US

V. Phone/Fax

Practice location:
  • Phone: 504-454-5213
  • Fax: 504-456-8053
Mailing address:
  • Phone: 504-454-5213
  • Fax: 504-456-8053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD09846R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD.09846R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: