Provider Demographics
NPI:1871726000
Name:VICK, MAURICE MCCALL JR (MD)
Entity type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:MCCALL
Last Name:VICK
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5225 ODONOVAN
Mailing Address - Street 2:STE 102
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-7202
Mailing Address - Country:US
Mailing Address - Phone:225-767-2686
Mailing Address - Fax:225-767-2687
Practice Address - Street 1:5225 ODONOVAN
Practice Address - Street 2:STE 102
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-7202
Practice Address - Country:US
Practice Address - Phone:225-767-2686
Practice Address - Fax:225-767-2687
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA009957207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology