19D0878294 CLIA NUMBER - WARREN J DEGATUR JR MD

Laboratory Demographics

  • CLIA Code: 19D0878294
  • Facility Name: WARREN J DEGATUR JR MD
  • Facility Address: 206 CHAMPAGNE BOULEVARD SUITE A
    BREAUX BRIDGE, LA
    ZIP 70517
  • Facility Phone: 337 332-3500
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: WARREN J. DEGATUR JR MD
  • NPI Number: 1720047079
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 19D0878294
LAB Type Physician Office
Facility Name WARREN J DEGATUR JR MD
Street 206 CHAMPAGNE BOULEVARD SUITE A
City BREAUX BRIDGE
State LA
ZIP 70517
Phone 337 332-3500
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 10/21/2025
Certificate Expiration Date 10/20/2027
Facility Type Physician Office
Lab Director WARREN J. DEGATUR JR MD

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This page was last updated on: 9/29/2025