Theriault, Victor Gaston
Theriault, Victor Gaston is an sole proprietor health care provider with primary practice located at 712 Willis Ave , Bogalusa LA 70427-3004. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Theriault, Victor Gaston can be contacted via phone (985) 732-4853.Contact Information
Primary practice address
712 Willis Ave
Bogalusa LA 70427-3004
Phone: (985) 732-4853
Fax: (985) 735-8883
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 014544 | Louisiana |
Profile Details
| NPI number | 1396742318 |
|---|---|
| LBN Legal business name | Theriault, Victor Gaston |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 5th, 2005 |
| Last updated | Sep 21st, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396742318 | NPPES |
| Louisiana | MEDICAID | 1181251 |
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