Provider Demographics
NPI:1912999707
Name:SOILEAU, EARL JOHN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:JOHN
Last Name:SOILEAU
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 123453 DEPT 3453
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-0001
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1525 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8849
Practice Address - Country:US
Practice Address - Phone:337-494-6767
Practice Address - Fax:337-494-6750
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAL017348207Q00000X, 207Q00000X
MD006704207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMD.017348OtherSTATE LICENSE
LA1341690Medicaid
LAMD.017348OtherSTATE LICENSE
LA5L850F808Medicare ID - Type Unspecified