Provider Demographics
NPI:1497709307
Name:BIENVENU, HAROLD G III (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:G
Last Name:BIENVENU
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:426 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3876
Mailing Address - Country:US
Mailing Address - Phone:337-365-4156
Mailing Address - Fax:337-365-4095
Practice Address - Street 1:426 CHARLES ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3876
Practice Address - Country:US
Practice Address - Phone:337-365-4156
Practice Address - Fax:337-365-4095
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.015116207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB61455Medicare UPIN