Provider Demographics
NPI:1417273996
Name:DOUCET, JOHN EDWARD JR (LSA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:DOUCET
Suffix:JR
Gender:M
Credentials:LSA
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Mailing Address - Street 1:7215 FOX STAR LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-6716
Mailing Address - Country:US
Mailing Address - Phone:832-527-9161
Mailing Address - Fax:866-730-5515
Practice Address - Street 1:7215 FOX STAR LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338
Practice Address - Country:US
Practice Address - Phone:832-527-9161
Practice Address - Fax:866-730-5515
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TX3545246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical