Healthcare Provider Details

I. General information

NPI: 1972683597
Provider Name (Legal Business Name): MEADE P O'BOYLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 MEDICAL PARK DR STE 3
MONROE LA
71203-2363
US

IV. Provider business mailing address

1217 DEAN CHAPEL RD
WEST MONROE LA
71291-7609
US

V. Phone/Fax

Practice location:
  • Phone: 318-966-6165
  • Fax: 318-966-6632
Mailing address:
  • Phone: 318-366-4002
  • Fax: 318-966-6165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4039R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: