Provider Demographics
NPI:1962819557
Name:RECONSTRUCTIVE BREAST SURGEONS OF ACADIANA
Entity Type:Organization
Organization Name:RECONSTRUCTIVE BREAST SURGEONS OF ACADIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DELATTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-269-4949
Mailing Address - Street 1:917 COOLIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2433
Mailing Address - Country:US
Mailing Address - Phone:337-269-4949
Mailing Address - Fax:337-269-4950
Practice Address - Street 1:917 COOLIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2433
Practice Address - Country:US
Practice Address - Phone:337-269-4949
Practice Address - Fax:337-269-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200512208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty