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Organization
PERIPHERAL VASCULAR, INC.
Active
Organization
PERIPHERAL VASCULAR, INC.
Active
Other names
Vasculab
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWARD W DAUTERIVE JR. M.D. (DOCTOR)
(337) 369-9309
Entity
Organization
Contact information
Practice address
1100 ANDRE ST STE 101, NEW IBERIA, LA 70563-2159
(337) 369-9309
(337) 365-8455
Mailing address
1100 ANDRE ST STE 101, NEW IBERIA, LA 70563-2159
(337) 369-9309
(337) 365-8455
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1339334
—
LA
Enumeration date
07/11/2006
Last updated
08/22/2020
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