Provider Demographics
NPI:1386631109
Name:DEGEYTER, ROLAND J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:J
Last Name:DEGEYTER
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 1:502 HAIFLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3854
Mailing Address - Country:US
Mailing Address - Phone:337-261-5151
Mailing Address - Fax:
Practice Address - Street 1:502 HAIFLEIGH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3854
Practice Address - Country:US
Practice Address - Phone:337-261-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1311898Medicaid
LA110003303OtherRAILROAD MEDICARE
LA1311898Medicaid
LA110003303OtherRAILROAD MEDICARE