Provider Demographics
NPI:1295872372
Name:WEIL, ERIC JOEL (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOEL
Last Name:WEIL
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 1:8415 GOODWOOD BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-7851
Mailing Address - Country:US
Mailing Address - Phone:225-765-8013
Mailing Address - Fax:225-765-2033
Practice Address - Street 1:8415 GOODWOOD BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7851
Practice Address - Country:US
Practice Address - Phone:225-765-8013
Practice Address - Fax:225-765-2033
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088960208000000X
LA204447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02486557Medicaid
LA2165658Medicaid
LA2165658Medicaid
4Q624DB46Medicare PIN