Provider Demographics
NPI:1639203367
Name:LOUD, SUYAH M (MD)
Entity Type:Individual
Prefix:DR
First Name:SUYAH
Middle Name:M
Last Name:LOUD
Suffix:
Gender:F
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:PO BOX 10824
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-0824
Mailing Address - Country:US
Mailing Address - Phone:337-364-4215
Mailing Address - Fax:480-247-4641
Practice Address - Street 1:4140 HOLLYWOOD AVE
Practice Address - Street 2:SUITE B-2
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71109-7818
Practice Address - Country:US
Practice Address - Phone:318-946-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD15815R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1612529Medicaid
LABL9037791OtherDEA NUMBER