Provider Demographics
NPI:1033115159
Name:PICOU, MARGUERITE B (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:B
Last Name:PICOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 KEYSER AVENUE
Mailing Address - Street 2:STE G
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-6239
Mailing Address - Country:US
Mailing Address - Phone:318-352-2971
Mailing Address - Fax:318-356-0850
Practice Address - Street 1:1029 KEYSER AVENUE
Practice Address - Street 2:STE G
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6239
Practice Address - Country:US
Practice Address - Phone:318-325-2971
Practice Address - Fax:318-356-0850
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2101803Medicaid
LA1352993Medicaid
52426DL99Medicare PIN
B63683Medicare UPIN
6443890001Medicare NSC
LA2101803Medicaid
6443890002Medicare NSC
LA52426Medicare PIN