Provider Demographics
NPI:1013986892
Name:MAYEAUX, STACEY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:WAYNE
Last Name:MAYEAUX
Suffix:
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0008
Mailing Address - Country:US
Mailing Address - Phone:337-678-3755
Mailing Address - Fax:337-678-3757
Practice Address - Street 1:519 E PRUDHOMME ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6499
Practice Address - Country:US
Practice Address - Phone:337-678-3755
Practice Address - Fax:337-678-3757
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA24994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1423271Medicaid
LAH45590Medicare UPIN
LA4A581DC40Medicare Oscar/Certification