Basic Information
| Provider Information | |||||||||
| NPI: | 1467846667 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOUQUE | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | VIAL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 604 N ACADIA RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703014897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854483700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 807 RIDGEFIELD RD | ||||||||
| Address2: | |||||||||
| City: | THIBODAUX | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703012755 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9854479045 | ||||||||
| FaxNumber: | 9854473349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2015 | ||||||||
| LastUpdateDate: | 01/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 311873 | LA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.