Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 320678 | LA |
N | 207QA0505X | Family Doctor - Adult Medicine | 320678 | LA |
NPI | 1346508777 |
---|---|
Provider Name | Dr. Ray Anthony Quebedeaux JR. |
First Address | Lafayette, LA 70506-3561 |
Second Address | Lafayette, LA 70506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 21/05/2021 |