Provider Demographics
NPI:1528023843
Name:SAUX, JACK E III (MD)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:E
Last Name:SAUX
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 54482
Mailing Address - Street 2:ATTN: NICOLE GOODWIN
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70154-4482
Mailing Address - Country:US
Mailing Address - Phone:985-898-4000
Mailing Address - Fax:
Practice Address - Street 1:1203 S TYLER ST STE 230
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2353
Practice Address - Country:US
Practice Address - Phone:985-892-9090
Practice Address - Fax:985-892-9957
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA09352R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1934445Medicaid
LA5R201Medicare PIN
F37059Medicare UPIN