Provider Demographics
NPI:1225069065
Name:LEDBETTER, JOHN L (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:LEDBETTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:210 LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-8548
Mailing Address - Country:US
Mailing Address - Phone:318-323-6405
Mailing Address - Fax:318-410-8290
Practice Address - Street 1:210 LAYTON AVE STE 20
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-8548
Practice Address - Country:US
Practice Address - Phone:318-323-6405
Practice Address - Fax:318-410-8290
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07192R208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1363812Medicaid
LA1363812Medicaid
LA52339Medicare ID - Type Unspecified