Provider Demographics
NPI:1487760989
Name:VERRETTE, PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:VERRETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1536
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70470-1536
Mailing Address - Country:US
Mailing Address - Phone:985-635-6943
Mailing Address - Fax:985-635-6948
Practice Address - Street 1:8050 W JUDGE PEREZ DR STE 2300
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1738
Practice Address - Country:US
Practice Address - Phone:504-826-9655
Practice Address - Fax:504-826-9656
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD017364207Q00000X
LA017364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA017364OtherLA LICENSE
LA1375471Medicaid
LA1444642Medicaid
LA2137689Medicaid
LA54150Medicare PIN
LAB65092Medicare UPIN
LA1444642Medicaid
LA017364OtherLA LICENSE
LA54150DS32Medicare PIN