Basic Information
| Provider Information | |||||||||
| NPI: | 1578630232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANDRENEAU | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | WAYNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1542 TULANE AVE | ||||||||
| Address2: | BOX T4-M2 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045684498 | ||||||||
| FaxNumber: | 5045682127 | ||||||||
| Practice Location | |||||||||
| Address1: | 1542 TULANE AVE | ||||||||
| Address2: | BOX T4-M2 | ||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701122865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045684498 | ||||||||
| FaxNumber: | 5045682127 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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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 | 207RG0100X | 204446 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.