Provider Demographics
NPI:1073574356
Name:CORNE, LOUIS MERAUX JR (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:MERAUX
Last Name:CORNE
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 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4019
Mailing Address - Fax:512-901-3919
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4019
Practice Address - Fax:512-901-3919
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23353208600000X
LAMD.201045208600000X
TXK9945208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218580301Medicaid
TXP01067579OtherRAILROAD MEDICARE
LA1583855Medicaid
OK200010900AMedicaid
OKH91031Medicare UPIN
LA1583855Medicaid
TXTXB117190Medicare PIN
LA4K351Medicare PIN
OK200010900AMedicaid
TX218580301Medicaid