Provider Demographics
NPI:1225076185
Name:SIMONEAUX, WALTER JOSEPH JR (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:JOSEPH
Last Name:SIMONEAUX
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 1:504 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD025595208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology