Provider Demographics
NPI:1154517696
Name:CORNELIUS L. MAYFIELD, M.D., L.L.C.
Entity type:Organization
Organization Name:CORNELIUS L. MAYFIELD, M.D., L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:LAFFITTE
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-214-4300
Mailing Address - Street 1:7777 HENNESSY BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-214-4300
Mailing Address - Fax:225-214-4303
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-214-4300
Practice Address - Fax:225-214-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12328R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1698989Medicaid
5CB57Medicare PIN
5Y686CB57Medicare PIN
LA1698989Medicaid