Provider Demographics
NPI:1134300577
Name:RENE L. DEBOISBLANC, MD LLC
Entity Type:Organization
Organization Name:RENE L. DEBOISBLANC, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEBOISBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-454-6338
Mailing Address - Street 1:4224 HOUMA BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2936
Mailing Address - Country:US
Mailing Address - Phone:504-454-6338
Mailing Address - Fax:
Practice Address - Street 1:4224 HOUMA BLVD STE 330
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2936
Practice Address - Country:US
Practice Address - Phone:504-454-6338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty