Provider Demographics
NPI:1871537266
Name:CHIASSON, BRETT JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:JOSEPH
Last Name:CHIASSON
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 1:1000 J.W. DAVIS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70454
Mailing Address - Country:US
Mailing Address - Phone:985-350-6505
Mailing Address - Fax:985-350-6509
Practice Address - Street 1:1000 J.W. DAVIS DRIVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70454
Practice Address - Country:US
Practice Address - Phone:985-350-6505
Practice Address - Fax:985-350-6509
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021220174400000X
LAMD.021220207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1534960Medicaid
LA6175360002OtherPALMETTO GBA CIGNA GOV. SERVICES
LAD06873OtherMEDICARE RAILROAD GROUP
LAP00699109OtherMEDICARE RAILROAD
LA1366455Medicaid
LA1534960Medicaid
LA1366455Medicaid
LA5DH38Medicare PIN