Provider Demographics
NPI:1124086459
Name:ST GERMAIN, DAVID J (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:ST GERMAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4300 HOUMA BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2924
Mailing Address - Country:US
Mailing Address - Phone:504-503-6791
Mailing Address - Fax:504-503-6710
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:STE 600
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2939
Practice Address - Country:US
Practice Address - Phone:504-503-6025
Practice Address - Fax:504-503-5201
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA014799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1311847Medicaid
LA55455Medicare ID - Type Unspecified
LA1311847Medicaid