Provider Demographics
NPI:1306070198
Name:MAGNE, JACQUELINE MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MARIE
Last Name:MAGNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3525 PRYTANIA ST
Mailing Address - Street 2:SUITE 606
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-8109
Mailing Address - Country:US
Mailing Address - Phone:504-899-1513
Mailing Address - Fax:504-897-8637
Practice Address - Street 1:3525 PRYTANIA ST
Practice Address - Street 2:SUITE 606
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-8109
Practice Address - Country:US
Practice Address - Phone:504-899-1513
Practice Address - Fax:504-897-8637
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.205212207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1925578Medicaid