Healthcare Provider Details

I. General information

NPI: 1528329950
Provider Name (Legal Business Name): JONATHAN LANCE BABIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 N ACADIA RD STE 207
THIBODAUX LA
70301-4897
US

IV. Provider business mailing address

604 N ACADIA RD STE 207
THIBODAUX LA
70301-4897
US

V. Phone/Fax

Practice location:
  • Phone: 985-446-1763
  • Fax: 985-446-9813
Mailing address:
  • Phone: 985-446-1763
  • Fax: 985-446-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD.206993
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.206993
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: