Provider Demographics
NPI:1174703789
Name:ROSEMARIE JACK CAILLIER,DPM
Entity type:Organization
Organization Name:ROSEMARIE JACK CAILLIER,DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:CAILLIER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:225-295-1900
Mailing Address - Street 1:PO BOX 84433
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-4433
Mailing Address - Country:US
Mailing Address - Phone:225-295-1900
Mailing Address - Fax:225-295-1906
Practice Address - Street 1:5516 SUPERIOR DR STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-8022
Practice Address - Country:US
Practice Address - Phone:225-295-1900
Practice Address - Fax:225-295-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPMPD227R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4730320001OtherDMERC
LA156430Medicaid
4730320001OtherDMERC
4730320001Medicare NSC
5CG01Medicare PIN