Provider Demographics
NPI:1992153621
Name:DR DANIEL G DUPREE LTD PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:DR DANIEL G DUPREE LTD PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEARB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-235-6886
Mailing Address - Street 1:1245 S COLLEGE RD
Mailing Address - Street 2:BLDG 5
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2917
Mailing Address - Country:US
Mailing Address - Phone:337-235-6886
Mailing Address - Fax:337-235-6892
Practice Address - Street 1:1245 S COLLEGE RD
Practice Address - Street 2:BLDG 5
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2917
Practice Address - Country:US
Practice Address - Phone:337-235-6886
Practice Address - Fax:337-235-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.012704174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1185426Medicaid
LA1185426Medicaid
LAB63104Medicare UPIN