Basic Information
| Provider Information | |||||||||
| NPI: | 1487760989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VERRETTE | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1536 | ||||||||
| Address2: | |||||||||
| City: | MANDEVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704701536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856356943 | ||||||||
| FaxNumber: | 9856356948 | ||||||||
| Practice Location | |||||||||
| Address1: | 8050 W JUDGE PEREZ DR STE 2300 | ||||||||
| Address2: | |||||||||
| City: | CHALMETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700431738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048269655 | ||||||||
| FaxNumber: | 5048269656 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD017364 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 017364 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 017364 | 01 | LA | LA LICENSE | OTHER | 1375471 | 05 | LA | MEDICAID | 1444642 | 05 | LA | MEDICAID | 2137689 | 05 | LA | MEDICAID |