Provider Demographics
NPI:1073660676
Name:DUPLANTIS, BRETT JUDE (PAC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:JUDE
Last Name:DUPLANTIS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 W 134TH ST
Mailing Address - Street 2:
Mailing Address - City:CUT OFF
Mailing Address - State:LA
Mailing Address - Zip Code:70345-4155
Mailing Address - Country:US
Mailing Address - Phone:985-632-8367
Mailing Address - Fax:985-632-7526
Practice Address - Street 1:144 W 134TH ST
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345-4155
Practice Address - Country:US
Practice Address - Phone:985-632-8367
Practice Address - Fax:985-632-7526
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10594.RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1625880Medicaid
LAQ13997Medicare UPIN
5CJ01PD70Medicare PIN