Basic Information
Provider Information | |||||||||
NPI: | 1568624492 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PAPASPYROS | ||||||||
FirstName: | GEORGE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 806 JEFFERSON TER | ||||||||
Address2: |   | ||||||||
City: | NEW IBERIA | ||||||||
State: | LA | ||||||||
PostalCode: | 705605727 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3373654945 | ||||||||
FaxNumber: | 3373766860 | ||||||||
Practice Location | |||||||||
Address1: | 315 S COLLEGE RD | ||||||||
Address2: | SUITE 220 | ||||||||
City: | LAFAYETTE | ||||||||
State: | LA | ||||||||
PostalCode: | 705033212 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3374567880 | ||||||||
FaxNumber: | 3374567882 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/01/2008 | ||||||||
LastUpdateDate: | 09/12/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 204651 | LA | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | 1062448 | 05 | LA |   | MEDICAID |