Provider Demographics
NPI:1538359419
Name:STEPHEN W. DARBONNE, LLC
Entity type:Organization
Organization Name:STEPHEN W. DARBONNE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:DARBONNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-857-2390
Mailing Address - Street 1:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-1254
Mailing Address - Country:US
Mailing Address - Phone:337-234-5656
Mailing Address - Fax:337-234-5670
Practice Address - Street 1:3215 E MILTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:YOUNGSVILLE
Practice Address - State:LA
Practice Address - Zip Code:70592-5546
Practice Address - Country:US
Practice Address - Phone:337-857-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA018186207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1368326Medicaid
LA1368326Medicaid