Healthcare Provider Details

I. General information

NPI: 1750356317
Provider Name (Legal Business Name): JOHN P VALLEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 01/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 S UNION ST
OPELOUSAS LA
70570-5725
US

IV. Provider business mailing address

120 RUE LOUIS XIV
LAFAYETTE LA
70508-5739
US

V. Phone/Fax

Practice location:
  • Phone: 337-594-2025
  • Fax:
Mailing address:
  • Phone: 337-769-7779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number14663R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: