| Doctor Name: | PERNELL JOSEPH SIMON |
| NPI Number: | 1699878124 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 021638 |
| Business Practice Address: | 207 Westmark Blvd Lafayette, LA - 705067365 |
| Business Phone Number: | 3379816811 |
| Business Fax Number: | 3379812024 |
| Mailing Address: | 207 Westmark Blvd, LAFAYETTE |
| State: | LA |
| Postal Code: | 705067365 |
| Phone Number: | 3379816811 |
| Fax Number: | 3379812024 |
| NPI Enumeration Date: | 09/07/2006 |
| NPI Last Update Date: | 09/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 021638 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |