Provider Demographics
NPI:1477607794
Name:TIFFANNY P CHEVALIER LLC
Entity Type:Organization
Organization Name:TIFFANNY P CHEVALIER LLC
Other - Org Name:TIFFANNY P CHEVALIER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D. OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANNY
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:CHEVALIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-927-7480
Mailing Address - Street 1:8786 GOODWOOD BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7917
Mailing Address - Country:US
Mailing Address - Phone:225-927-7480
Mailing Address - Fax:225-927-7486
Practice Address - Street 1:8786 GOODWOOD BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7917
Practice Address - Country:US
Practice Address - Phone:225-927-7480
Practice Address - Fax:225-927-7486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14016R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1189685Medicaid