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General NPI Number Information
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NPI Number | 1457557977
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Entity Type | Organization
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Legal Business Name | LAFAYETTE PEDIATRIC NEUROLOGY CENTER, LLC
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 4650 AMBASSADOR CAFFERY PKWY SUITE 103
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City | LAFAYETTE
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State | LA
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Zip | 70508-6926
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Country | US
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Telephone | 337-993-7391
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Fax |
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Provider Business Mailing Address
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Address Line | 4650 AMBASSADOR CAFFERY PKWY SUITE 103
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City | LAFAYETTE
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State | LA
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Zip | 70508-6926
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Country | US
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Telephone | 337-993-7391
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | ROBERT J LAGESSE
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Credential |
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Telephone | 504-988-7044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | LA
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