1184732208 NPI number — B C DELAHOUSSAYE, JR., M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184732208 NPI number — B C DELAHOUSSAYE, JR., M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B C DELAHOUSSAYE, JR., M.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184732208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1307 CROWLEY-RAYNE HWY.
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CROWLEY
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-783-3861
Provider Business Mailing Address Fax Number:
337-788-1849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1307 CROWLEY RAYNE HWY
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CROWLEY
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70526-8210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-783-3861
Provider Business Practice Location Address Fax Number:
337-788-1849
Provider Enumeration Date:
08/28/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DELA HOUSSAYE
Authorized Official First Name:
B
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
337-783-3861

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  009323 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1097110 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".