Provider Demographics
NPI:1407906928
Name:OLIVIER, MAUREEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:
Last Name:OLIVIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 NELSON RD
Mailing Address - Street 2:BUILDING E SUITE 1
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4148
Mailing Address - Country:US
Mailing Address - Phone:337-474-1386
Mailing Address - Fax:337-474-2845
Practice Address - Street 1:4150 NELSON RD
Practice Address - Street 2:BUILDING E SUITE 1
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4148
Practice Address - Country:US
Practice Address - Phone:337-474-1386
Practice Address - Fax:337-474-2845
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015309207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1300586Medicaid
LA015309OtherSTATE LICENSE
LA54443Medicare ID - Type Unspecified
LAB65253Medicare UPIN
LA1300586Medicaid
LA544437460Medicare PIN