Provider Demographics
NPI:1740578525
Name:KENNETH J. LABORDE, M.D. APMC
Entity Type:Organization
Organization Name:KENNETH J. LABORDE, M.D. APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:LABORDE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:337-232-8230
Mailing Address - Street 1:1000 W PINHOOK RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2460
Mailing Address - Country:US
Mailing Address - Phone:337-232-8230
Mailing Address - Fax:337-232-9112
Practice Address - Street 1:1000 W PINHOOK RD
Practice Address - Street 2:SUITE 302
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2460
Practice Address - Country:US
Practice Address - Phone:337-232-8230
Practice Address - Fax:337-232-9112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013814208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1308030Medicaid
LAB89932Medicare UPIN
LA1308030Medicaid