Provider Demographics
NPI:1235290412
Name:KENNETH C LAFLEUR, M.D.
Entity Type:Organization
Organization Name:KENNETH C LAFLEUR, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAFLEUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-892-3225
Mailing Address - Street 1:1110 DOCTOR AC TERRENCE BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6403
Mailing Address - Country:US
Mailing Address - Phone:337-942-3613
Mailing Address - Fax:
Practice Address - Street 1:1110 DOCTOR AC TERRENCE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6403
Practice Address - Country:US
Practice Address - Phone:985-892-3225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010446332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0298520001Medicare NSC