Provider Demographics
NPI:1326078577
Name:BAQUET, PATRICK SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:SHAWN
Last Name:BAQUET
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 1:1100 ANDRE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2159
Mailing Address - Country:US
Mailing Address - Phone:337-560-1750
Mailing Address - Fax:337-560-4241
Practice Address - Street 1:1100 ANDRE ST STE 205
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2159
Practice Address - Country:US
Practice Address - Phone:337-560-1750
Practice Address - Fax:337-560-4241
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026119207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1052736Medicaid
LA7424615OtherAETNA
LAH95154Medicare UPIN
LA4F506Medicare PIN