Provider Demographics
NPI:1619030384
Name:METOYER, JOHN D (CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
Last Name:METOYER
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 1:715 PATRICK RD
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-2927
Mailing Address - Country:US
Mailing Address - Phone:318-470-3201
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3908
Practice Address - Country:US
Practice Address - Phone:318-212-4072
Practice Address - Fax:318-212-8650
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55637-1880367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1960322Medicaid
LA1960322Medicaid
LA5S858C734Medicare PIN