Provider Demographics
NPI:1336133008
Name:HEBERT, WAYBRUN J III (DPM)
Entity Type:Individual
Prefix:
First Name:WAYBRUN
Middle Name:J
Last Name:HEBERT
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W TUNNEL BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4049
Mailing Address - Country:US
Mailing Address - Phone:985-868-2973
Mailing Address - Fax:985-879-3116
Practice Address - Street 1:1025 W TUNNEL BLVD
Practice Address - Street 2:STE. B
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4049
Practice Address - Country:US
Practice Address - Phone:985-868-2973
Practice Address - Fax:985-879-3116
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD184R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1695785Medicaid
LA5Y341Medicare ID - Type Unspecified
LA4177950001Medicare NSC
LAU65401Medicare UPIN