# LAKE PROFESSIONALS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497313670
- **Authorized official:** MR. DOUGLASS H PERRET (CEO)
- **Authorized official phone:** (337) 233-1114

## Contact information

- **Practice address:** 501 W SAINT MARY BLVD STE 210, LAFAYETTE, LA 70506-4699
- **Practice address phone:** (337) 233-1114
- **Mailing address:** PO BOX 53388, LAFAYETTE, LA 70505-3388
- **Mailing address phone:** (337) 233-1114

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/03/2019
- **Last updated:** 04/25/2023