Provider Demographics
NPI:1275532186
Name:COUSIN, GEORGE B (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:B
Last Name:COUSIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2309 E MAIN ST
Mailing Address - Street 2:STE 400
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4046
Mailing Address - Country:US
Mailing Address - Phone:337-367-0271
Mailing Address - Fax:337-364-6139
Practice Address - Street 1:2309 E MAIN ST
Practice Address - Street 2:STE 400
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4046
Practice Address - Country:US
Practice Address - Phone:337-367-0271
Practice Address - Fax:337-364-6139
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA016174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1339814Medicaid
LA1339814Medicaid
LA5L711Medicare PIN