Basic Information
| Provider Information | |||||||||
| NPI: | 1609141985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PREJEAN | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 DUNN ST | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703604440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858760300 | ||||||||
| FaxNumber: | 9858765529 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 DUNN ST | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703604440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858760300 | ||||||||
| FaxNumber: | 9858765529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2012 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD.35013 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD.206244 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 206244 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | MD.35013 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RI0011X | 206244 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RA0001X | 206244 | LA | Y |
No ID Information.