Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | L017239 | LA |
N | 207YS0123X | Facial Plastic Surgeon | L017239 | LA |
NPI | 1770581811 |
---|---|
Provider Name | Dr. Bradley J Chastant |
First Address | Lafayette, LA 70503-2464 |
Second Address | Lafayette, LA 70503-2464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070007863 | RR MED (01) | LA |
1443727 | (05) | LA |
B63960 | (02) |