Provider Demographics
NPI:1609808294
Name:BOULIGNY, RANDY PETER (MD)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:PETER
Last Name:BOULIGNY
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 1:409 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3633
Mailing Address - Country:US
Mailing Address - Phone:985-735-8137
Mailing Address - Fax:985-732-4777
Practice Address - Street 1:409 AVENUE F
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427-3633
Practice Address - Country:US
Practice Address - Phone:504-455-1816
Practice Address - Fax:504-887-7816
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021802207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1627593Medicaid
LA4J882F670Medicare PIN
G58083Medicare UPIN
LAG58083Medicare UPIN
LA4J882Medicare PIN
LA4J882F669Medicare PIN
LAP00632760Medicare PIN
LA4J882F668Medicare PIN