Healthcare Provider Details

I. General information

NPI: 1295962538
Provider Name (Legal Business Name): JAMES EMMETT POISSO JR. OPA-C, SA-C, R.T.(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2009
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 JEFFERSON TER SUITE 100
NEW IBERIA LA
70560-4980
US

IV. Provider business mailing address

307 N LEWIS ST
NEW IBERIA LA
70563-2842
US

V. Phone/Fax

Practice location:
  • Phone: 337-364-5310
  • Fax: 337-364-5313
Mailing address:
  • Phone: 337-560-9425
  • Fax: 337-364-5313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: