Provider Demographics
NPI:1932109451
Name:BOOS, MICHAEL WILFRED PROSPER JR (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:WILFRED PROSPER
Last Name:BOOS
Suffix:JR
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 1:4640 AMBASSADOR CAFFERY PKWY
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6902
Mailing Address - Country:US
Mailing Address - Phone:337-984-1050
Mailing Address - Fax:337-984-8776
Practice Address - Street 1:4640 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6902
Practice Address - Country:US
Practice Address - Phone:337-984-1050
Practice Address - Fax:337-984-8776
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13759207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309257Medicaid
B62505Medicare UPIN
LA1309257Medicaid