Provider Demographics
NPI:1164676664
Name:LOYD H BOULET JR MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LOYD H BOULET JR MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOYD
Authorized Official - Middle Name:HONORE
Authorized Official - Last Name:BOULET
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-942-6324
Mailing Address - Street 1:1270 ATTAKAPAS DR
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6549
Mailing Address - Country:US
Mailing Address - Phone:337-942-6324
Mailing Address - Fax:
Practice Address - Street 1:1270 ATTAKAPAS DR
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6549
Practice Address - Country:US
Practice Address - Phone:337-942-6324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009095208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty