Provider Demographics
NPI:1043288160
Name:MONIER, CHARLES J JR (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:J
Last Name:MONIER
Suffix:JR
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 1:764 N ACADIA RD
Mailing Address - Street 2:STE A
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-5009
Mailing Address - Country:US
Mailing Address - Phone:985-446-1958
Mailing Address - Fax:
Practice Address - Street 1:602 N ACADIA RD
Practice Address - Street 2:SUITE 101
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-446-1958
Practice Address - Fax:985-446-7889
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA019105207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1386171Medicaid
LAD87056Medicare UPIN
LA55734Medicare ID - Type Unspecified