Provider Demographics
NPI:1386637130
Name:BER, LESLIE CHAUVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:CHAUVIN
Last Name:BER
Suffix:
Gender:F
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 968
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-0968
Mailing Address - Country:US
Mailing Address - Phone:985-448-3737
Mailing Address - Fax:985-448-3736
Practice Address - Street 1:5642 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-1250
Practice Address - Country:US
Practice Address - Phone:985-448-3737
Practice Address - Fax:985-448-3736
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0224222080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490318Medicaid