Provider Demographics
NPI:1598822215
Name:STEPHEN M PERSON MD LTD
Entity Type:Organization
Organization Name:STEPHEN M PERSON MD LTD
Other - Org Name:STEPHEN M PERSON MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR - CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KANE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-269-0963
Mailing Address - Street 1:439 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2616
Mailing Address - Country:US
Mailing Address - Phone:337-269-0963
Mailing Address - Fax:337-269-0553
Practice Address - Street 1:439 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2616
Practice Address - Country:US
Practice Address - Phone:337-269-0963
Practice Address - Fax:337-269-0553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty