Provider Demographics
NPI:1679558639
Name:DESPINASSE, BRIAN II (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:DESPINASSE
Suffix:II
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:PO BOX 15179
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70895-5179
Mailing Address - Country:US
Mailing Address - Phone:225-922-8377
Mailing Address - Fax:225-930-0260
Practice Address - Street 1:730 COLONIAL DR STE B
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6536
Practice Address - Country:US
Practice Address - Phone:225-922-8377
Practice Address - Fax:225-930-0260
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23350208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490903Medicaid
LA1490903Medicaid