Provider Demographics
NPI:1174501316
Name:LEDOUX, CHARLES J JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:LEDOUX
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:502 BARROW ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4606
Mailing Address - Country:US
Mailing Address - Phone:985-868-4890
Mailing Address - Fax:985-876-7413
Practice Address - Street 1:502 BARROW ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4606
Practice Address - Country:US
Practice Address - Phone:985-868-4890
Practice Address - Fax:985-876-7413
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012736208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA119985Medicaid
LA119985Medicaid
LAB64837Medicare UPIN
LA537697392Medicare PIN