Provider Demographics
NPI:1497762207
Name:COUVILLION, JOHN T (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:COUVILLION
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 1:10202 JEFFERSON HWY STE D
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3183
Mailing Address - Country:US
Mailing Address - Phone:225-768-8833
Mailing Address - Fax:225-769-4839
Practice Address - Street 1:10202 JEFFERSON HWY STE D
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3183
Practice Address - Country:US
Practice Address - Phone:225-768-8833
Practice Address - Fax:225-769-4839
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021851174400000X
LAMD.021851207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1499234Medicaid
G79802Medicare UPIN
LA5E396Medicare PIN