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NPI Code Detail

MEDICARE: JAKE GARRETT DUHON MED., ATC, LAT

MEDICARE: JAKE GARRETT DUHON MED., ATC, LAT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerJ00218LA

General Provider Information

NPI Number : 1700821543
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAKE GARRETT DUHON MED., ATC, LAT
Provider Business Mailing Address
First Line : 3341 KIRKPATRICK DR
Second Line :
City : JENNINGS
State : LA
Zip : 70546-3256
Country : US
Telephone Number : 337-616-9383
Fax Number : 337-824-4548
Provider Business Practice Location Address
First Line : 2002 JOHNSON ST
Second Line : STE. 100
City : JENNINGS
State : LA
Zip : 70546-3646
Country : US
Telephone Number : 337-824-4547
Fax Number : 337-824-4548
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2006
Last Update Date : 06/07/2010

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