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Individual

MR. MARC THOMAS HEBERT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
Mailing address
1747 IMPERIAL BLVD, LAKE CHARLES, LA 70605-5362
(337) 721-7236
(337) 721-7237

Taxonomy

Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA200015
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1812994
LA
01
5D847P624
MEDICARE LEGACY NUMBER
LA
01
P02589614
RAILROAD MEDICARE
LA
Enumeration date
07/27/2006
Last updated
01/25/2021
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