Individual
DR. RICHARD MICHAEL JEANSONNE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
521 ASBURY DRIVE, MANDEVILLE, LA 70471
(985) 630-9618
(985) 231-7010
Mailing address
716 TUNICA BND, COVINGTON, LA 70433-4573
(601) 493-4229
(985) 231-7010
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
18605
MS
207Q00000X
Family Medicine Physician
Primary
MD.025708
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09702861
—
MS
05
—
1048585
—
LA
Enumeration date
07/31/2006
Last updated
03/17/2018
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