Individual
CHARLES BALETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1119 S TYLER ST, COVINGTON, LA 70433
(985) 875-9166
(985) 875-9170
Mailing address
1417 STILLWATER DR, MANDEVILLE, LA 70471-7452
(985) 875-9166
(985) 875-9170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12664R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1539571
—
LA
Enumeration date
04/26/2006
Last updated
06/28/2018
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