Provider Demographics
NPI:1972683597
Name:O'BOYLE, MEADE P (MD)
Entity Type:Individual
Prefix:DR
First Name:MEADE
Middle Name:P
Last Name:O'BOYLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1217 DEAN CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-7609
Mailing Address - Country:US
Mailing Address - Phone:318-366-4002
Mailing Address - Fax:318-966-6165
Practice Address - Street 1:3510 MEDICAL PARK DR STE 3
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2363
Practice Address - Country:US
Practice Address - Phone:318-966-6165
Practice Address - Fax:318-966-6632
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA4039R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1306860Medicaid