Provider Demographics
NPI:1568485423
Name:WOLTERING, EUGENE ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:ANTHONY
Last Name:WOLTERING
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 1:200 W ESPLANADE AVE
Mailing Address - Street 2:SUTIE 200
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2489
Mailing Address - Country:US
Mailing Address - Phone:504-464-8500
Mailing Address - Fax:504-646-8525
Practice Address - Street 1:200 W ESPLANADE AVE
Practice Address - Street 2:SUTIE 200
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2489
Practice Address - Country:US
Practice Address - Phone:504-464-8500
Practice Address - Fax:504-646-8525
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09723R208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1978850Medicaid
MS09435858Medicaid
LA910000289Medicare PIN
LA5U001F669Medicare PIN
MS09435858Medicaid
LA5U001F670Medicare PIN
A81801Medicare UPIN