Provider Demographics
NPI:1063584928
Name:COLEMAN DAIGLE, J RENEE (MD)
Entity type:Individual
Prefix:
First Name:J
Middle Name:RENEE
Last Name:COLEMAN DAIGLE
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 1:3700 SAINT CHARLES AVE
Mailing Address - Street 2:FL 3
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4637
Mailing Address - Country:US
Mailing Address - Phone:225-526-0001
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:3700 SAINT CHARLES AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4637
Practice Address - Country:US
Practice Address - Phone:504-210-4291
Practice Address - Fax:504-210-4291
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.019865207Q00000X
LA019865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1933031Medicaid
F29733Medicare UPIN