Healthcare Provider Details

I. General information

NPI: 1538359419
Provider Name (Legal Business Name): STEPHEN W. DARBONNE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 07/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 E MILTON AVE SUITE 1
YOUNGSVILLE LA
70592-5546
US

IV. Provider business mailing address

PO BOX 1254
BROUSSARD LA
70518-1254
US

V. Phone/Fax

Practice location:
  • Phone: 337-857-2390
  • Fax:
Mailing address:
  • Phone: 337-234-5656
  • Fax: 337-234-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number018186
License Number StateLA

VIII. Authorized Official

Name: STEPHEN W DARBONNE
Title or Position: M.D.
Credential: M.D.
Phone: 337-857-2390