Provider Demographics
NPI:1497999098
Name:TRAHAN, MAXIE A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAXIE
Middle Name:A
Last Name:TRAHAN
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 1:717 N EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-3856
Mailing Address - Country:US
Mailing Address - Phone:337-783-1629
Mailing Address - Fax:337-783-1137
Practice Address - Street 1:717 N EASTERN AVE
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-3856
Practice Address - Country:US
Practice Address - Phone:337-783-1629
Practice Address - Fax:337-783-1137
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LAMD.206805208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1928151Medicaid
LA362446YJRAMedicare PIN