Provider Demographics
NPI:1417117573
Name:ARDOIN, SARAH LATIOLAIS (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LATIOLAIS
Last Name:ARDOIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATHERINE
Other - Last Name:LATIOLAIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:153 TOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6971
Mailing Address - Country:US
Mailing Address - Phone:337-942-4453
Mailing Address - Fax:337-948-0900
Practice Address - Street 1:153 TOWN BLVD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6971
Practice Address - Country:US
Practice Address - Phone:337-942-4453
Practice Address - Fax:337-948-0900
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.202929208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1095257Medicaid