Provider Demographics
NPI:1952506750
Name:DEBLANC, THEODORE WENSEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:WENSEL
Last Name:DEBLANC
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 1:1270 ATTAKAPAS DR STE 502
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6530
Mailing Address - Country:US
Mailing Address - Phone:337-942-9977
Mailing Address - Fax:337-942-8006
Practice Address - Street 1:1270 ATTAKAPAS DR STE 502
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6530
Practice Address - Country:US
Practice Address - Phone:337-942-9977
Practice Address - Fax:337-942-8006
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017665207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1371424Medicaid
LAG42453Medicare UPIN
LA53821Medicare ID - Type Unspecified