Provider Demographics
NPI:1093915894
Name:PERRET, PHILIP S (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:PERRET
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 1:614 W SAINT MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3538
Mailing Address - Country:US
Mailing Address - Phone:337-232-6435
Mailing Address - Fax:337-232-0152
Practice Address - Street 1:614 W SAINT MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3538
Practice Address - Country:US
Practice Address - Phone:337-232-6435
Practice Address - Fax:337-232-0152
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4507R207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1197301Medicaid
13616OtherBLUE CROSS OF LA
13616OtherBLUE CROSS OF LA
54621Medicare PIN