Provider Demographics
NPI:1104102029
Name:DUMAS MEDICAL GROUP LLC
Entity type:Organization
Organization Name:DUMAS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-592-9818
Mailing Address - Street 1:2121 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-5045
Mailing Address - Country:US
Mailing Address - Phone:504-592-9818
Mailing Address - Fax:504-525-0152
Practice Address - Street 1:2121 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-5045
Practice Address - Country:US
Practice Address - Phone:504-592-9818
Practice Address - Fax:504-525-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025449208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1579378Medicaid
LAH37748Medicare UPIN