Healthcare Provider Details

I. General information

NPI: 1588640064
Provider Name (Legal Business Name): STEPHEN W DARBONNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 EAST MILTON AVENUE 1
YOUNGSVILLE LA
70592-5738
US

IV. Provider business mailing address

3215 EAST MILTON AVENUE 1
YOUNGSVILLE LA
70592-5738
US

V. Phone/Fax

Practice location:
  • Phone: 337-857-2390
  • Fax: 337-857-2392
Mailing address:
  • Phone: 337-857-2390
  • Fax: 337-857-2392

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:
Title or Position:
Credential:
Phone: