Provider Demographics
NPI:1093970642
Name:MONTEGUT, CHRISTIAN LYLE (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTIAN
Middle Name:LYLE
Last Name:MONTEGUT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:429 WEST AIRLINE HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAPLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3817
Mailing Address - Country:US
Mailing Address - Phone:985-652-3344
Mailing Address - Fax:985-652-9320
Practice Address - Street 1:429 WEST AIRLINE HWY
Practice Address - Street 2:SUITE B
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3817
Practice Address - Country:US
Practice Address - Phone:985-652-3344
Practice Address - Fax:985-652-9320
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2012-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA203596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1181056Medicaid
LA1181056Medicaid