1861691503 NPI number — DR. VICTOR JOHNSON VAUTROT M.D.

Table of content: DR. VICTOR JOHNSON VAUTROT M.D. (NPI 1861691503)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861691503 NPI number — DR. VICTOR JOHNSON VAUTROT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAUTROT
Provider First Name:
VICTOR
Provider Middle Name:
JOHNSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861691503
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1174 BRIGMAN HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUNICE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70535-7759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-258-3685
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2495 SHREVEPORT HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEVILLE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71360-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-258-3685
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  203416 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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