Provider Demographics
NPI:1801901335
Name:LAPEROUSE, PATRICK ANTOINE (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ANTOINE
Last Name:LAPEROUSE
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 1:439 HEYMANN BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2616
Mailing Address - Country:US
Mailing Address - Phone:337-269-0963
Mailing Address - Fax:337-269-0553
Practice Address - Street 1:439 HEYMANN BLVD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2616
Practice Address - Country:US
Practice Address - Phone:337-269-0963
Practice Address - Fax:337-269-0553
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA026011207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1055549Medicaid
I36748Medicare UPIN
LA4J798Medicare PIN
4J798DM92Medicare PIN