Provider Demographics
NPI:1992140701
Name:DEGEYTER AND ROSSITTER MEDICAL RESEARCH AND DEVELOPMENT LLC
Entity type:Organization
Organization Name:DEGEYTER AND ROSSITTER MEDICAL RESEARCH AND DEVELOPMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEGEYTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-981-2949
Mailing Address - Street 1:204 LO SAAB CV
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6276
Mailing Address - Country:US
Mailing Address - Phone:337-298-4485
Mailing Address - Fax:
Practice Address - Street 1:2810 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-5906
Practice Address - Country:US
Practice Address - Phone:337-981-2949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty