Provider Demographics
NPI:1093906323
Name:PITRE, SIMONE THERESE (MD)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:THERESE
Last Name:PITRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 RUE DE SANTE
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5404
Mailing Address - Country:US
Mailing Address - Phone:985-652-2441
Mailing Address - Fax:
Practice Address - Street 1:4608 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:RACELAND
Practice Address - State:LA
Practice Address - Zip Code:70394
Practice Address - Country:US
Practice Address - Phone:985-537-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201411207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00209806Medicaid
LA1091308Medicaid
LA4M207Medicare PIN
MS00209806Medicaid