Healthcare Provider Details

I. General information

NPI: 1740869791
Provider Name (Legal Business Name): ALIX LAYA TROMBLAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2021
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST
JACKSON MS
39216-4500
US

IV. Provider business mailing address

142 NORMANDIE DR
OPELOUSAS LA
70570-6869
US

V. Phone/Fax

Practice location:
  • Phone: 601-815-8489
  • Fax:
Mailing address:
  • Phone: 337-290-6987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV2303
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: