Provider Demographics
NPI:1750484887
Name:HEBERT, DAVID BRUCE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRUCE
Last Name:HEBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HOUMAS CT
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:LA
Mailing Address - Zip Code:70452
Mailing Address - Country:US
Mailing Address - Phone:985-863-2861
Mailing Address - Fax:
Practice Address - Street 1:2364 GAUSE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4141
Practice Address - Country:US
Practice Address - Phone:985-641-2202
Practice Address - Fax:985-641-2888
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013798207V00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1334987Medicaid
MS00014732Medicaid
LA323350YH3UMedicare PIN
MS00014732Medicaid
LA52244DC36Medicare PIN
LA52244Medicare PIN