=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427108968
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACQUES C PELTIER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 12/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15813 PAUL VEGA MD DR STE 300
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70403-1431
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-230-2630
-----------------------------------------------------
Fax | 985-230-2634
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2668 NORTH OAKS ENT & ALLERGY CLINIC
-----------------------------------------------------
City | HAMMOND
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70404-2668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-230-2630
-----------------------------------------------------
Fax | 985-230-2634
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | BP30020108
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | MD.201345
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------