Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | L017348 | LA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 006704 | MD |
NPI | 1912999707 |
---|---|
Provider Name | Earl J Soileau JR. |
First Address | Dallas, TX 75312-0001 |
Second Address | Lake Charles, LA 70601-8849 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 07/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1341690 | (05) | LA |
AS2345115 | RAILROAD MEDICARE (01) | |
MD.017348 | STATE LICENSE (01) | LA |