Provider Demographics
NPI:1306903752
Name:M. ANGELA MAYEUX, MD APMC
Entity type:Organization
Organization Name:M. ANGELA MAYEUX, MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:MAYEUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-235-1600
Mailing Address - Street 1:1000 WEST PINHOOK RD
Mailing Address - Street 2:STE 305
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503
Mailing Address - Country:US
Mailing Address - Phone:337-235-1600
Mailing Address - Fax:337-235-1604
Practice Address - Street 1:1000 WEST PINHOOK RD
Practice Address - Street 2:STE 305
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-235-1600
Practice Address - Fax:337-235-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2009-06-18
Deactivation Date:2008-12-17
Deactivation Code:
Reactivation Date:2009-01-14
Provider Licenses
StateLicense IDTaxonomies
LA019577174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448044Medicaid
LA0874080001Medicare NSC
LA1448044Medicaid