Provider Demographics
NPI:1962815126
Name:JAYME TRAHAN, MD PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:JAYME TRAHAN, MD PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:JAYME TRAHAN, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SELF
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-501-0356
Mailing Address - Street 1:1103 KALISTE SALOOM RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5784
Mailing Address - Country:US
Mailing Address - Phone:337-234-5234
Mailing Address - Fax:337-210-5367
Practice Address - Street 1:1103 KALISTE SALOOM RD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5784
Practice Address - Country:US
Practice Address - Phone:337-234-5234
Practice Address - Fax:337-210-5367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-05
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203227207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty