Provider Demographics
NPI:1124026802
Name:PERRON, ANDRE KEATH (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:KEATH
Last Name:PERRON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 62600
Mailing Address - Street 2:DEPT 1721
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70162-2600
Mailing Address - Country:US
Mailing Address - Phone:337-706-1645
Mailing Address - Fax:
Practice Address - Street 1:1216 CAMELLIA BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6667
Practice Address - Country:US
Practice Address - Phone:337-769-0069
Practice Address - Fax:337-769-0068
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA009981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1100943Medicaid