Provider Demographics
NPI:1801005590
Name:J A BADEAUX III MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:J A BADEAUX III MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:J.
Authorized Official - Middle Name:A
Authorized Official - Last Name:BADEAUX
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:318-443-8380
Mailing Address - Street 1:2108 TEXAS AVE STE 3061
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3903
Mailing Address - Country:US
Mailing Address - Phone:318-443-8380
Mailing Address - Fax:318-443-6079
Practice Address - Street 1:2108 TEXAS AVE STE 3061
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301
Practice Address - Country:US
Practice Address - Phone:318-443-8380
Practice Address - Fax:318-443-6079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09174R207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF38852Medicare UPIN