Healthcare Provider Details

I. General information

NPI: 1033553284
Provider Name (Legal Business Name): ALLISON CORMIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 ENTERPRISE DR STE B
HOUMA LA
70360-5405
US

IV. Provider business mailing address

605 ENTERPRISE DR STE B
HOUMA LA
70360-5405
US

V. Phone/Fax

Practice location:
  • Phone: 985-262-1639
  • Fax: 985-262-8197
Mailing address:
  • Phone: 985-262-1639
  • Fax: 985-262-8197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number1033553284
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number308698
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: