Provider Demographics
NPI:1326078395
Name:YONGUE, MARY MARELLE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARELLE
Last Name:YONGUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:GARY
Other - Middle Name:
Other - Last Name:SCHOELERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:335 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-5040
Mailing Address - Country:US
Mailing Address - Phone:337-332-5505
Mailing Address - Fax:337-482-6826
Practice Address - Street 1:UNIVERSITY OF LOUISIANA LAFAYETTE STUDENT HEALTH SERV
Practice Address - Street 2:120 BOUCHER DR.
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70504-0001
Practice Address - Country:US
Practice Address - Phone:337-482-6826
Practice Address - Fax:337-482-6428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13862207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1301892Medicaid
LA5J555Medicare ID - Type Unspecified
LA1301892Medicaid