Provider Demographics
NPI:1649303330
Name:SUGENG, BUDI N (MD)
Entity type:Individual
Prefix:MR
First Name:BUDI
Middle Name:N
Last Name:SUGENG
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 1:1305 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70510-2825
Mailing Address - Country:US
Mailing Address - Phone:337-422-6240
Mailing Address - Fax:337-422-6241
Practice Address - Street 1:1305 N STATE ST
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-2825
Practice Address - Country:US
Practice Address - Phone:337-422-6240
Practice Address - Fax:337-422-6241
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200292208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330531Medicaid
LA200292OtherMD
LA33165OtherLA BOARD OF PHARMACY
LA33165OtherLA BOARD OF PHARMACY
9627021OtherBS US DEA