Provider Demographics
NPI:1790346849
Name:CHOUEST, LANEY JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:LANEY
Middle Name:JOSEPH
Last Name:CHOUEST
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:PO BOX 2340
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-2340
Mailing Address - Country:US
Mailing Address - Phone:504-569-0032
Mailing Address - Fax:
Practice Address - Street 1:11075 NICOLLE BLVD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:LA
Practice Address - Zip Code:70094-2939
Practice Address - Country:US
Practice Address - Phone:504-569-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.014568251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.014568OtherLA STATE BOARD OF MEDICAL EXAMINERS