Provider Demographics
NPI:1457919409
Name:LAVESPERE, BLAKE RANDALL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:RANDALL
Last Name:LAVESPERE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:3921 CLERMONT DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70122-4811
Mailing Address - Country:US
Mailing Address - Phone:318-623-0823
Mailing Address - Fax:
Practice Address - Street 1:4315 HOUMA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2941
Practice Address - Country:US
Practice Address - Phone:504-702-3000
Practice Address - Fax:504-889-5451
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2022-03-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant