Provider Demographics
NPI:1033150784
Name:DEVALCOURT, TODD A (PA)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:DEVALCOURT
Suffix:
Gender:M
Credentials:PA
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 919229
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9229
Mailing Address - Country:US
Mailing Address - Phone:337-703-3201
Mailing Address - Fax:337-703-3202
Practice Address - Street 1:4212 W CONGRESS ST STE 3100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6771
Practice Address - Country:US
Practice Address - Phone:337-703-3201
Practice Address - Fax:337-703-3202
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAP.A.A10538363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00249834OtherRAILROAD
P00362071Medicare PIN
LAP00249834OtherRAILROAD
LA5C006P669Medicare PIN
LA5U977P763Medicare PIN