Provider Demographics
NPI:1952302796
Name:CHIASSON, EDWARD RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RAYMOND
Last Name:CHIASSON
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-765-2048
Mailing Address - Fax:225-765-1958
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-765-2048
Practice Address - Fax:225-765-1958
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14404208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1303674Medicaid
MS07538811Medicaid
5L943CR65Medicare PIN
LA1303674Medicaid