Provider Demographics
NPI:1326184581
Name:BOULIGNY, ANTHONY JOHN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:BOULIGNY
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5459 STILLWATER DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-3412
Mailing Address - Country:US
Mailing Address - Phone:504-245-6374
Mailing Address - Fax:504-589-1382
Practice Address - Street 1:701 LOYOLA AVE
Practice Address - Street 2:MEDICAL UNIT RM 2008
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1912
Practice Address - Country:US
Practice Address - Phone:504-589-1174
Practice Address - Fax:504-589-1382
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA013653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1192783Medicaid
LA1192783Medicaid
LAB62194Medicare UPIN