Provider Demographics
NPI:1386618908
Name:DIAL, DANIEL IRWIN (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:IRWIN
Last Name:DIAL
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 1:10880 JOOR ROAD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818
Mailing Address - Country:US
Mailing Address - Phone:225-262-7710
Mailing Address - Fax:225-262-7714
Practice Address - Street 1:2524 LAUREL LAKES AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70820-5736
Practice Address - Country:US
Practice Address - Phone:225-769-4171
Practice Address - Fax:225-262-7714
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA11123R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1663387Medicaid
LA5W206Medicare ID - Type Unspecified
LA1663387Medicaid
LA5W206Medicare PIN