Provider Demographics
NPI:1225064348
Name:SIMONEAUX UROLOGY LLC
Entity Type:Organization
Organization Name:SIMONEAUX UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMONEAUX
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-448-3055
Mailing Address - Street 1:504 N ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4862
Mailing Address - Country:US
Mailing Address - Phone:985-448-3055
Mailing Address - Fax:985-447-5670
Practice Address - Street 1:504 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4862
Practice Address - Country:US
Practice Address - Phone:985-448-3055
Practice Address - Fax:985-447-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD025595208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty