Provider Demographics
NPI:1972538155
Name:FALGOUT, JOHN M (NP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:FALGOUT
Suffix:
Gender:M
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1990 INDUSTRIAL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7055
Mailing Address - Country:US
Mailing Address - Phone:985-868-9300
Mailing Address - Fax:985-851-0053
Practice Address - Street 1:1990 INDUSTRIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70363-7055
Practice Address - Country:US
Practice Address - Phone:985-868-9300
Practice Address - Fax:985-851-0053
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP02049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1682004Medicaid
LA3B4547627Medicare PIN
LA5T997Medicare PIN
LA1682004Medicaid