Provider Demographics
NPI:1174563126
Name:JENNIFER WAGUESPACK LABICHE MD LLC
Entity type:Organization
Organization Name:JENNIFER WAGUESPACK LABICHE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:WAGUESPACK-LABICHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-839-2773
Mailing Address - Street 1:803 ALBERTSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-5096
Mailing Address - Country:US
Mailing Address - Phone:337-839-2773
Mailing Address - Fax:337-839-2776
Practice Address - Street 1:803 ALBERTSON PKWY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-5096
Practice Address - Country:US
Practice Address - Phone:337-839-2773
Practice Address - Fax:337-839-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CU51Medicare PIN
LADF0934Medicare PIN