Provider Demographics
NPI:1588834410
Name:COMEAUX, JEREMY ALLEN SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:ALLEN
Last Name:COMEAUX
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15475 AIRLINE HWY
Mailing Address - Street 2:BLDG C
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70817-7314
Mailing Address - Country:US
Mailing Address - Phone:225-408-2820
Mailing Address - Fax:225-408-2829
Practice Address - Street 1:15475 AIRLINE HWY
Practice Address - Street 2:BLDG C
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-7314
Practice Address - Country:US
Practice Address - Phone:225-408-2820
Practice Address - Fax:225-408-2829
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-06
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LABU3479335212208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation