Provider Demographics
NPI:1245237221
Name:LADD, WILLIAM RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RICHARD
Last Name:LADD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4176
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70361-4176
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:225 DUNN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4413
Practice Address - Country:US
Practice Address - Phone:985-876-0300
Practice Address - Fax:985-872-0317
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015290207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1301744Medicaid
LA060042315OtherRR MEDICARE
LA1301744Medicaid
LAB61396Medicare UPIN