Provider Demographics
NPI:1962449769
Name:ALBERT R CORNE JR MD
Entity Type:Organization
Organization Name:ALBERT R CORNE JR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-232-8511
Mailing Address - Street 1:457 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2616
Mailing Address - Country:US
Mailing Address - Phone:337-232-8511
Mailing Address - Fax:337-234-3591
Practice Address - Street 1:457 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2616
Practice Address - Country:US
Practice Address - Phone:337-232-8511
Practice Address - Fax:337-234-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009830174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1103136Medicaid
LAC67418Medicare UPIN
LA51420Medicare ID - Type UnspecifiedMEDICARE