Organization
STACEY W MAYEAUX MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STACEY WAYNE MAYEAUX MD (OWNER OPERATOR)
(337) 678-3755
Entity
Organization
Contact information
Practice address
519 E PRUDHOMME ST, OPELOUSAS, LA 70570-6499
(337) 678-3755
(337) 678-3757
Mailing address
PO BOX 8, OPELOUSAS, LA 70571-0008
(337) 678-3755
(337) 678-3757
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013986892
NPI
LA
05
—
1423271
—
LA
Enumeration date
01/14/2008
Last updated
10/31/2017
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