Provider Demographics
NPI:1518997253
Name:HEBERT, BYRON RAY (CRNA)
Entity Type:Individual
Prefix:
First Name:BYRON
Middle Name:RAY
Last Name:HEBERT
Suffix:
Gender:M
Credentials:CRNA
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 977
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70511-0977
Mailing Address - Country:US
Mailing Address - Phone:337-892-7634
Mailing Address - Fax:337-892-7634
Practice Address - Street 1:204 N MAGDALEN SQ
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4645
Practice Address - Country:US
Practice Address - Phone:337-893-4531
Practice Address - Fax:337-893-0825
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN045176 AP02303367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1390631Medicaid
LA1390631Medicaid