Provider Demographics
NPI:1912088030
Name:BEVROTTE, LOUIS H (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:H
Last Name:BEVROTTE
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:P.O. BOX 4148
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70178-4148
Mailing Address - Country:US
Mailing Address - Phone:504-207-3060
Mailing Address - Fax:
Practice Address - Street 1:3201 S CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-4307
Practice Address - Country:US
Practice Address - Phone:504-207-3060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1135640Medicaid
LA011674OtherLA. MEDICAL #