Provider Demographics
NPI:1184732208
Name:B C DELAHOUSSAYE, JR., M.D.
Entity type:Organization
Organization Name:B C DELAHOUSSAYE, JR., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:B
Authorized Official - Middle Name:C
Authorized Official - Last Name:DELA HOUSSAYE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-783-3861
Mailing Address - Street 1:1307 CROWLEY-RAYNE HWY.
Mailing Address - Street 2:SUITE A
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526
Mailing Address - Country:US
Mailing Address - Phone:337-783-3861
Mailing Address - Fax:337-788-1849
Practice Address - Street 1:1307 CROWLEY RAYNE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-8210
Practice Address - Country:US
Practice Address - Phone:337-783-3861
Practice Address - Fax:337-788-1849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009323207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1097110Medicaid
LA1097110Medicaid
LA51492Medicare ID - Type Unspecified