1326184581 NPI number — DR. ANTHONY JOHN BOULIGNY SR. M.D.

Table of content: DR. ANTHONY JOHN BOULIGNY SR. M.D. (NPI 1326184581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326184581 NPI number — DR. ANTHONY JOHN BOULIGNY SR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOULIGNY
Provider First Name:
ANTHONY
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
SR.
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:
1326184581
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5459 STILLWATER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70128-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-245-6374
Provider Business Mailing Address Fax Number:
504-589-1382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 LOYOLA AVE
Provider Second Line Business Practice Location Address:
MEDICAL UNIT RM 2008
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70113-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-589-1174
Provider Business Practice Location Address Fax Number:
504-589-1382
Provider Enumeration Date:
01/29/2007

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: 207R00000X , with the licence number:  013653 , 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)

  • Identifier: 1192783 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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