Provider Demographics
NPI:1023039476
Name:BERTHELOT, LIBEAU JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:LIBEAU
Middle Name:JOSEPH
Last Name:BERTHELOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54482
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4482
Mailing Address - Country:US
Mailing Address - Phone:985-839-9895
Mailing Address - Fax:
Practice Address - Street 1:82525 HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-6111
Practice Address - Country:US
Practice Address - Phone:985-839-9895
Practice Address - Fax:985-839-9884
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013196207Q00000X
LAMD.013196207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1300624Medicaid
LA5J233D060Medicare PIN
LAP00082586Medicare PIN
LAB60374Medicare UPIN
LA1300624Medicaid
LA5J233Medicare PIN