Healthcare Provider Details

I. General information

NPI: 1952366031
Provider Name (Legal Business Name): RAND SEBASTIAN METOYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GAUSE BLVD E SUITE 201
SLIDELL LA
70461-5442
US

IV. Provider business mailing address

501 KEYSER AVE
NATCHITOCHES LA
71457-6018
US

V. Phone/Fax

Practice location:
  • Phone: 985-649-5825
  • Fax: 985-645-0884
Mailing address:
  • Phone: 318-214-4153
  • Fax: 318-214-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number020497
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: