Provider Demographics
NPI:1740343243
Name:JEANFREAU AND JEANFREAU LLC
Entity type:Organization
Organization Name:JEANFREAU AND JEANFREAU LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANFREAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-779-5859
Mailing Address - Street 1:3800 HOUMA BLVD
Mailing Address - Street 2:SUITE 335
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4182
Mailing Address - Country:US
Mailing Address - Phone:504-779-5859
Mailing Address - Fax:985-626-6995
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:SUITE 335
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4182
Practice Address - Country:US
Practice Address - Phone:504-779-5859
Practice Address - Fax:985-626-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5C886Medicare ID - Type Unspecified
CH8941Medicare PIN