Provider Demographics
NPI:1467418277
Name:FAUGOT, MAURICE B (MD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:B
Last Name:FAUGOT
Suffix:
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 1:295 INDEST ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-1719
Mailing Address - Country:US
Mailing Address - Phone:337-365-5437
Mailing Address - Fax:337-369-6922
Practice Address - Street 1:295 INDEST ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-1719
Practice Address - Country:US
Practice Address - Phone:337-365-5437
Practice Address - Fax:337-369-6922
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD014151208000000X
LALA014151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1304336Medicaid
LA1304336Medicaid