Provider Demographics
NPI:1588640064
Name:DARBONNE, STEPHEN W (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:W
Last Name:DARBONNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3215 EAST MILTON AVENUE
Mailing Address - Street 2:1
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70592-5738
Mailing Address - Country:US
Mailing Address - Phone:337-857-2390
Mailing Address - Fax:337-857-2392
Practice Address - Street 1:3215 EAST MILTON AVENUE
Practice Address - Street 2:1
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5738
Practice Address - Country:US
Practice Address - Phone:337-857-2390
Practice Address - Fax:337-857-2392
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA018186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA13-68326Medicaid
LAB65186Medicare UPIN
LA54315Medicare ID - Type Unspecified