Individual
CLARENCE WHITEHEAD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
600 N LEWIS ST, NEW IBERIA, LA 70563-2043
(800) 893-9698
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
022961
LA
208600000X
Surgery Physician
Primary
022961
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1683906
—
LA
01
—
P00285996
RAILROAD MEDICARE
—
Enumeration date
05/01/2006
Last updated
09/15/2015
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