Provider Demographics
NPI:1417042953
Name:LOUIS, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:LOUIS
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 1:875 ISLAND DR STE A
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6700
Mailing Address - Country:US
Mailing Address - Phone:510-457-1776
Mailing Address - Fax:
Practice Address - Street 1:350 30TH STREET
Practice Address - Street 2:SUITE 540
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3487
Practice Address - Country:US
Practice Address - Phone:510-836-0223
Practice Address - Fax:510-836-8791
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G392310Medicaid
01005183OtherRAILROAD MEDICARE
CADE435ZOtherPTAN (INDIVIDUAL)
CA00G392310Medicare PIN
A47746Medicare UPIN
CA00G392310Medicaid