Basic Information
| Provider Information | |||||||||
| NPI: | 1386631109 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEGEYTER | ||||||||
| FirstName: | ROLAND | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 HAIFLEIGH ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705383854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372615151 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 502 HAIFLEIGH ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705383854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372615151 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 11/08/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 013214 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1311898 | 05 | LA | MEDICAID | 110003303 | 01 | LA | RAILROAD MEDICARE | OTHER |