Provider Demographics
NPI:1366549065
Name:MEHAFFEY, STEVEN DICK (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DICK
Last Name:MEHAFFEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:23749 FLETCHER ISLE
Mailing Address - Street 2:
Mailing Address - City:PONCHATOULA
Mailing Address - State:LA
Mailing Address - Zip Code:70454-6833
Mailing Address - Country:US
Mailing Address - Phone:985-370-7758
Mailing Address - Fax:504-469-1979
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:KENNER REGIONAL MEDICAL CENTER
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-464-8686
Practice Address - Fax:504-464-8174
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAL03844R207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385026Medicaid
LA55554Medicare ID - Type Unspecified
LA1385026Medicaid