Healthcare Provider Details

I. General information

NPI: 1740317221
Provider Name (Legal Business Name): MARK B. CHARBONNET, MD APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 N LEWIS ST SUITE 600
NEW IBERIA LA
70563-2093
US

IV. Provider business mailing address

PO BOX 12109
NEW IBERIA LA
70562-2109
US

V. Phone/Fax

Practice location:
  • Phone: 337-560-5510
  • Fax:
Mailing address:
  • Phone: 337-560-5510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberL023042
License Number StateLA

VIII. Authorized Official

Name: DR. MARK BARTON CHARBONNET
Title or Position: PHYSICIAN
Credential: MD
Phone: 337-560-5510