Provider Demographics
NPI:1881648277
Name:WOJAK, JOAN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:C
Last Name:WOJAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 52545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2545
Mailing Address - Country:US
Mailing Address - Phone:337-470-2180
Mailing Address - Fax:337-470-2677
Practice Address - Street 1:4801 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6917
Practice Address - Country:US
Practice Address - Phone:337-470-2180
Practice Address - Fax:337-470-2677
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08359R2085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1660434Medicaid
LA300063026Medicare PIN
LAG04332Medicare UPIN
LA1660434Medicaid