Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD.206244 | LA |
N | 111NI0900X | Internist | MD.206244 | LA |
N | 207R00000X | Internist | MD.35013 | AL |
N | 111NI0900X | Internist | MD.35013 | AL |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 206244 | LA |
N | 207RC0000X | Internist - Cardiovascular Disease | 206244 | LA |
N | 207RI0011X | Interventional Cardiology | 206244 | LA |
N | 207RI0011X | Interventional Cardiology | MD.35013 | AL |
NPI | 1609141985 |
---|---|
Provider Name | Shane Paul Prejean |
First Address | Houma, LA 70360-4440 |
Second Address | Houma, LA 70360-4440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 19/08/2021 |