Lisa Breaux Black, MD
Clinic/Center, Primary Care in Houma, LA. Organization (NPI-2).
NPI number1164088134
StatusActive
Last updated in NPPESJun 11, 2019
Details
- NPI
- 1164088134
- Entity type
- Organization (NPI-2)
- Legal business name
- Lisa Breaux Black, MD
- Organization subpart
- No
- Enumeration date
- May 15, 2019
- Last updated
- Jun 11, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | – | – | Yes |
Other names
- La Vie A Family Practice (Doing Business As)
Practice location
895 Verret StHouma, LA 70360-4635
Phone 985-200-3225 · Fax 985-746-1204
Mailing address
895 Verret StHouma, LA 70360-4635
Phone 985-200-3225 · Fax 985-746-1204
Authorized official
Heather Malbrough
Office Administrator
9856659173
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