Healthcare Provider Details

I. General information

NPI: 1649210709
Provider Name (Legal Business Name): JOHN G LEMIEUX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 E MAIN ST
NEW IBERIA LA
70560-4031
US

IV. Provider business mailing address

PO BOX 9774
NEW IBERIA LA
70562-9774
US

V. Phone/Fax

Practice location:
  • Phone: 337-367-1048
  • Fax: 337-367-0131
Mailing address:
  • Phone: 337-367-1048
  • Fax: 337-357-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number13032R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: