Provider Demographics
NPI:1669708624
Name:KENNETH E MCCARRON MD PMC
Entity type:Organization
Organization Name:KENNETH E MCCARRON MD PMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCARRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-261-1919
Mailing Address - Street 1:1211 COOLIDGE BLVD
Mailing Address - Street 2:STE 301
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2636
Mailing Address - Country:US
Mailing Address - Phone:337-261-1919
Mailing Address - Fax:337-261-1599
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:STE 301
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-261-1919
Practice Address - Fax:337-261-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DL17Medicare PIN