Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 204845 | LA |
Y | 111NI0900X | Internist | 204845 | LA |
NPI | 1003074907 |
---|---|
Provider Name | Dr. Bradley John Chastant II |
First Address | Lafayette, LA 70503-2616 |
Second Address | Lafayette, LA 70503-2616 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2008 |
Last Update Date | 07/05/2013 |