Provider Demographics
NPI:1124220306
Name:AMBEAUX, LOUIS IRVIN JR (PA)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:IRVIN
Last Name:AMBEAUX
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2074
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0040
Mailing Address - Country:US
Mailing Address - Phone:936-328-8944
Mailing Address - Fax:
Practice Address - Street 1:604 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-3451
Practice Address - Country:US
Practice Address - Phone:936-328-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01279363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N263Medicare ID - Type Unspecified
TXS39826Medicare UPIN