Provider Demographics
NPI:1922150309
Name:PICCIONE, PAUL WAYNE (PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WAYNE
Last Name:PICCIONE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16777 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3254
Mailing Address - Country:US
Mailing Address - Phone:225-751-6666
Mailing Address - Fax:225-751-6680
Practice Address - Street 1:16777 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3254
Practice Address - Country:US
Practice Address - Phone:225-751-6666
Practice Address - Fax:225-751-6680
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.A10419.RX363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA33774OtherCDS
LA33774OtherCDS
MP1478773OtherDEA