Provider Demographics
NPI:1548255938
Name:FALGOUST, QUENTIN D (MD)
Entity type:Individual
Prefix:
First Name:QUENTIN
Middle Name:D
Last Name:FALGOUST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 AUDUBON AVE
Mailing Address - Street 2:STE N-5
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4957
Mailing Address - Country:US
Mailing Address - Phone:985-446-0506
Mailing Address - Fax:985-446-7614
Practice Address - Street 1:1101 AUDUBON AVE
Practice Address - Street 2:STE N-5
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4957
Practice Address - Country:US
Practice Address - Phone:985-446-0506
Practice Address - Fax:985-446-7614
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010914207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1127264Medicaid
LA1127264Medicaid
LA51179Medicare ID - Type Unspecified
LA1319950001Medicare NSC