Provider Demographics
NPI:1669823142
Name:LAFAYETTE WEIGHT LOSS CLINIC, LLC
Entity Type:Organization
Organization Name:LAFAYETTE WEIGHT LOSS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MYRON
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-456-3553
Mailing Address - Street 1:5439 JOHNSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-5135
Mailing Address - Country:US
Mailing Address - Phone:337-456-3553
Mailing Address - Fax:337-408-3347
Practice Address - Street 1:5439 JOHNSTON ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-5135
Practice Address - Country:US
Practice Address - Phone:337-456-3553
Practice Address - Fax:337-408-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.020878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty