Provider Demographics
NPI:1730189580
Name:BLANDA, LOUIS CHARLES JR (MD)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:CHARLES
Last Name:BLANDA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1103 KALISTE SALOOM ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-2636
Mailing Address - Country:US
Mailing Address - Phone:337-234-5234
Mailing Address - Fax:337-235-2121
Practice Address - Street 1:1103 KALISTE SALOOM ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-2636
Practice Address - Country:US
Practice Address - Phone:337-234-5234
Practice Address - Fax:337-235-2121
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011186207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1117579Medicaid
LA200000951OtherRAILROAD
LA1117579Medicaid
LA200000951OtherRAILROAD