Provider Demographics
NPI:1518321827
Name:NEUPERT, DEREK GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:GERARD
Last Name:NEUPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-493-4544
Mailing Address - Fax:985-493-3091
Practice Address - Street 1:726 N ACADIA RD STE 2300
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5078
Practice Address - Country:US
Practice Address - Phone:985-493-3090
Practice Address - Fax:985-493-3091
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA3228502084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program