Healthcare Provider Details

I. General information

NPI: 1497709307
Provider Name (Legal Business Name): HAROLD G BIENVENU III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 CHARLES ST
NEW IBERIA LA
70560-3876
US

IV. Provider business mailing address

426 CHARLES ST
NEW IBERIA LA
70560-3876
US

V. Phone/Fax

Practice location:
  • Phone: 337-365-4156
  • Fax: 337-365-4095
Mailing address:
  • Phone: 337-365-4156
  • Fax: 337-365-4095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberMD.015116
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: