Healthcare Provider Details

I. General information

NPI: 1285068098
Provider Name (Legal Business Name): DON A FALGOUT CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4608 HWY 1
RACELAND LA
70394
US

IV. Provider business mailing address

4608 HWY 1
RACELAND LA
70394
US

V. Phone/Fax

Practice location:
  • Phone: 985-537-6841
  • Fax:
Mailing address:
  • Phone: 958-537-6841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP07402
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: