Provider Demographics
NPI:1598834491
Name:HEBERT, WILLIAM GERRY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GERRY
Last Name:HEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 3RD AVENUE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-494-6800
Mailing Address - Fax:337-494-6811
Practice Address - Street 1:2770 3RD AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8994
Practice Address - Country:US
Practice Address - Phone:337-494-6800
Practice Address - Fax:337-494-6811
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL021253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1967629Medicaid
LA5U272Medicare ID - Type Unspecified
LAF777375Medicare UPIN