Provider Demographics
NPI:1437201035
Name:LEDET, JANICE PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:PATRICK
Last Name:LEDET
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 1:2106 NORTH RAGUET ST.
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75961
Mailing Address - Country:US
Mailing Address - Phone:936-468-4008
Mailing Address - Fax:936-468-1316
Practice Address - Street 1:2106 NORTH RAGUET ST.
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961
Practice Address - Country:US
Practice Address - Phone:936-468-4008
Practice Address - Fax:936-468-1316
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B24300Medicare UPIN