Provider Demographics
NPI:1962443473
Name:MARRIONEAUX, ORY SAMUEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ORY
Middle Name:SAMUEL
Last Name:MARRIONEAUX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 SUMMA AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3726
Mailing Address - Country:US
Mailing Address - Phone:225-762-5586
Mailing Address - Fax:
Practice Address - Street 1:8150 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-664-2029
Practice Address - Fax:225-763-9693
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA10227RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00400060Medicaid
LA2350161Medicaid
LA339835YH3VMedicare PIN