Provider Demographics
NPI:1962691279
Name:JOLIVETTE, MILTON JOSEPH JR (MEDICAL DOCTOR)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:JOSEPH
Last Name:JOLIVETTE
Suffix:JR
Gender:M
Credentials:MEDICAL DOCTOR
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Mailing Address - Street 1:501 W SAINT MARY BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-4600
Mailing Address - Country:US
Mailing Address - Phone:337-234-1945
Mailing Address - Fax:337-232-6380
Practice Address - Street 1:501 W SAINT MARY BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4600
Practice Address - Country:US
Practice Address - Phone:337-234-1945
Practice Address - Fax:337-232-6380
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
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Provider Licenses
StateLicense IDTaxonomies
LA04373R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA52021OtherMEDICARE
LA1195367Medicaid