Provider Demographics
NPI:1215992813
Name:DAUNIS, MARK STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:DAUNIS
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:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-5726
Mailing Address - Fax:985-230-6653
Practice Address - Street 1:1900 S MORRISON BLVD
Practice Address - Street 2:WALK-IN CLINIC
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-230-5726
Practice Address - Fax:985-230-5683
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.020192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1979317Medicaid
LA1979317Medicaid
5R850Medicare ID - Type Unspecified