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General NPI Number Information
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NPI Number | 1164676664
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Entity Type | Organization
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Legal Business Name | LOYD H BOULET JR MD A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/11/2008
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 1270 ATTAKAPAS DR
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City | OPELOUSAS
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State | LA
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Zip | 70570-6549
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Country | US
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Telephone | 337-942-6324
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 ATTAKAPAS DR
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City | OPELOUSAS
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State | LA
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Zip | 70570-6549
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Country | US
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Telephone | 337-942-6324
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOYD HONORE BOULET JR.
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Credential | MD
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Telephone | 337-942-6324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 009095
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License Number State | LA
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