Provider Demographics
NPI:1528066248
Name:CHUA, JESUS LAO (MD)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:LAO
Last Name:CHUA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 HAIFLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-3731
Mailing Address - Country:US
Mailing Address - Phone:337-828-4037
Mailing Address - Fax:337-828-7740
Practice Address - Street 1:602 HAIFLEIGH ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-3731
Practice Address - Country:US
Practice Address - Phone:337-828-4037
Practice Address - Fax:337-828-7740
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA09772R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1969036Medicaid
LAF59350Medicare UPIN
LA1969036Medicaid