Provider Demographics
NPI:1699781591
Name:MONETTE, BRIAN D (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:MONETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1725
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70107-1725
Mailing Address - Country:US
Mailing Address - Phone:225-621-5770
Mailing Address - Fax:225-644-5168
Practice Address - Street 1:1112 E ASCENSION COMPLEX AVE.
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737
Practice Address - Country:US
Practice Address - Phone:225-921-5770
Practice Address - Fax:225-644-5168
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAR019642 / L0237862084A0401X, 2084P0800X, 2084P0804X
LA0237862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1480789Medicaid
H24980Medicare UPIN
LA1480789Medicaid