Healthcare Provider Details

I. General information

NPI: 1952488033
Provider Name (Legal Business Name): LON M BARONNE DPM BARONNE FOOT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 S UNION ST
OPELOUSAS LA
70570-5738
US

IV. Provider business mailing address

PO BOX 159
OPELOUSAS LA
70571-0159
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-7567
  • Fax: 337-948-4993
Mailing address:
  • Phone: 337-942-7567
  • Fax: 337-948-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: TERESA KOLDER
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-942-7567