Provider Demographics
NPI:1649372574
Name:LANGIE, JACQUELINE SLAUGHTER (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:SLAUGHTER
Last Name:LANGIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 FLORIDA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806
Mailing Address - Country:US
Mailing Address - Phone:225-650-2000
Mailing Address - Fax:225-650-2099
Practice Address - Street 1:3140 FLORIDA BOULEVARD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-650-2000
Practice Address - Fax:225-650-2099
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1311553Medicaid
LAB64421Medicare UPIN
LA1311553Medicaid