Provider Demographics
NPI:1922011030
Name:DEBOISBLANC, RENE L (MD)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:L
Last Name:DEBOISBLANC
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 1:4224 HOUMA BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2936
Mailing Address - Country:US
Mailing Address - Phone:504-454-6338
Mailing Address - Fax:504-456-8016
Practice Address - Street 1:4224 HOUMA BLVD STE 330
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2936
Practice Address - Country:US
Practice Address - Phone:504-454-6338
Practice Address - Fax:504-456-8016
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1146129Medicaid
LA5M146B447Medicare ID - Type Unspecified
LA1146129Medicaid