Provider Demographics
NPI:1073900148
Name:DAVID J. DREZ, JR., M.D., A MEDICAL CORP
Entity type:Organization
Organization Name:DAVID J. DREZ, JR., M.D., A MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:DREZ, JR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-824-3819
Mailing Address - Street 1:4700 W CYPRESS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5978
Mailing Address - Country:US
Mailing Address - Phone:337-824-3819
Mailing Address - Fax:337-824-0160
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:JENNINGS
Practice Address - State:LA
Practice Address - Zip Code:70546-3641
Practice Address - Country:US
Practice Address - Phone:337-824-3819
Practice Address - Fax:337-824-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009625174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty