Provider Demographics
NPI:1619962479
Name:LEDET, WALTER PIERRE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:PIERRE
Last Name:LEDET
Suffix:JR
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 1:914 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-5107
Mailing Address - Country:US
Mailing Address - Phone:337-527-6363
Mailing Address - Fax:337-528-2168
Practice Address - Street 1:914 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-5107
Practice Address - Country:US
Practice Address - Phone:337-527-6363
Practice Address - Fax:337-528-2168
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA070975208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA721115080 70663 A003OtherTRICARE
LA1816312002OtherCIGNA
LA5136427OtherAETNA
LA1145670Medicaid
LA721115080 70663 A003OtherTRICARE
LA1816312002OtherCIGNA