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Organization
MANDEVILLE PRIVATE PHYSICIAN GROUP
Active
Organization
MANDEVILLE PRIVATE PHYSICIAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD MICHAEL JEANSONNE JR. MD (PHYSICIAN)
(985) 630-9618
Entity
Organization
Contact information
Practice address
141 LAKEVIEW CIR, COVINGTON, LA 70433-7513
(985) 630-9618
(985) 231-7010
Mailing address
PO BOX 335, MANDEVILLE, LA 70470-0335
(985) 630-9618
(985) 231-7010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
025708
LA
Other
Enumeration date
10/16/2014
Last updated
05/01/2017
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