Provider Demographics
NPI:1669229647
Name:DWAYNE J BERGEAUX MD NEPHROLOGY & HYPERTENSION
Entity type:Organization
Organization Name:DWAYNE J BERGEAUX MD NEPHROLOGY & HYPERTENSION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-788-2864
Mailing Address - Street 1:1325 WRIGHT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-2226
Mailing Address - Country:US
Mailing Address - Phone:337-788-2864
Mailing Address - Fax:337-788-2866
Practice Address - Street 1:1325 WRIGHT AVE STE B
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-2226
Practice Address - Country:US
Practice Address - Phone:337-788-2864
Practice Address - Fax:337-788-2866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-06
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty