Provider Demographics
NPI:1639531130
Name:PADGETT, MD, STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PADGETT, MD
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 1:1211 COOLIDGE STREET
Mailing Address - Street 2:SUITE 405
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2638
Mailing Address - Country:US
Mailing Address - Phone:337-233-7524
Mailing Address - Fax:337-233-7567
Practice Address - Street 1:1211 COOLIDGE STREET
Practice Address - Street 2:SUITE 405
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2638
Practice Address - Country:US
Practice Address - Phone:337-233-7524
Practice Address - Fax:337-233-7567
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA321976207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2412795Medicaid