Provider Demographics
NPI:1083803563
Name:DARBY, ALVIN (MD)
Entity type:Individual
Prefix:
First Name:ALVIN
Middle Name:
Last Name:DARBY
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 1:541 S MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4419
Mailing Address - Country:US
Mailing Address - Phone:504-415-6176
Mailing Address - Fax:
Practice Address - Street 1:200 S LEWIS ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3916
Practice Address - Country:US
Practice Address - Phone:337-321-4168
Practice Address - Fax:337-321-6275
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07143R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1360601Medicaid
LA1360601Medicaid