Wallace Jeanfreau Jr., M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

015285 Issued in LA

Practice address

3530 Houma Blvd
Metairie, LA 70006-4202

Phone

(504) 264-5142

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580428800000",
    "number": "1518065978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 HOUMA BLVD",
            "address_2": "SUITE 335",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700064182",
            "telephone_number": "504-779-5859",
            "fax_number": "985-626-6995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3530 HOUMA BLVD",
            "city": "METAIRIE",
            "state": "LA",
            "postal_code": "700064202",
            "telephone_number": "504-264-5142"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3800 Houma Blvd",
            "address_2": "Suite 335",
            "address_purpose": "LOCATION",
            "city": "Metairie",
            "state": "LA",
            "postal_code": "700064182",
            "country_code": "US",
            "telephone_number": "504-779-5859",
            "fax_number": "985-626-6995",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JEANFREAU",
        "first_name": "WALLACE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "LA",
            "license": "015285",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1329088",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeanfreau and Jeanfreau LLC
• Lindsey Jeanfreau
• Michael Jeanfreau, PHARM D.
• Robert Jeanfreau, M.D.
• Susan Grenier Jeanfreau, M.D.
• Shavon Jeanpierre
• Gabrielle Jeansonne I
• Jeffcare
• Jefferson Ambulatory Surgery Center LLC
• Jefferson Headache and Spine,L.L.C.

• Internal Medicine Physician in Metairie, LA
• Providers in Metairie, LA by specialty
• Internal Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.