Jeanne D. Theriot Md Apmllc | |
112 Champagne Blvd Breaux Bridge LA 70517-3852 | |
(337) 332-2242 | |
Not Available |
Full Name | Jeanne D. Theriot Md Apmllc |
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Speciality | Family Medicine |
Location | 112 Champagne Blvd, Breaux Bridge, Louisiana |
Authorized Official Name and Position | Jeanne Dauphine Theriot (OWNER/DIRECTOR) |
Authorized Official Contact | 3373322242 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Jeanne D. Theriot Md Apmllc 112 Champagne Blvd Breaux Bridge LA 70517-3852 Ph: (337) 332-2242 | Jeanne D. Theriot Md Apmllc 112 Champagne Blvd Breaux Bridge LA 70517-3852 Ph: (337) 332-2242 |
NPI Number | 1174581342 |
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Provider Enumeration Date | 05/03/2006 |
Last Update Date | 03/10/2008 |
Medicare PECOS PAC ID | 9234239815 |
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Medicare Enrollment ID | O20070711000793 |
Identifier | Type | State | Issuer |
---|---|---|---|
1174581342 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (Louisiana) | Primary |
Provider Name | Jeanne D Theriot |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1093763625 PECOS PAC ID: 4688686900 Enrollment ID: I20060630000285 |
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