Provider Demographics
NPI:1417906306
Name:BARONNE, LON M (DPM)
Entity Type:Individual
Prefix:
First Name:LON
Middle Name:M
Last Name:BARONNE
Suffix:
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0159
Mailing Address - Country:US
Mailing Address - Phone:337-942-7567
Mailing Address - Fax:337-948-4993
Practice Address - Street 1:2848 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5738
Practice Address - Country:US
Practice Address - Phone:337-942-7567
Practice Address - Fax:337-948-4993
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD082-R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1376469Medicaid
LA1376469Medicaid
T19703Medicare UPIN