Lake Professionals LLC
General Practice in Lafayette, LA. Organization (NPI-2).
NPI number1497313670
StatusActive
Last updated in NPPESApr 25, 2023
Details
- NPI
- 1497313670
- Entity type
- Organization (NPI-2)
- Legal business name
- Lake Professionals LLC
- Organization subpart
- No
- Enumeration date
- Jun 3, 2019
- Certification date
- Apr 25, 2023
- Last updated
- Apr 25, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
Practice location
501 W Saint Mary Blvd Ste 210Lafayette, LA 70506-4699
Phone 337-233-1114
Mailing address
Po Box 53388Lafayette, LA 70505-3388
Phone 337-233-1114
Authorized official
Douglass H Perret
Ceo
3372331114
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