Provider Demographics
NPI:1073547592
Name:DULITZ, DAVID ALAN (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:DULITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 HOUMA BLVD
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2920
Mailing Address - Country:US
Mailing Address - Phone:504-888-0388
Mailing Address - Fax:504-888-9119
Practice Address - Street 1:3941 HOUMA BLVD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2920
Practice Address - Country:US
Practice Address - Phone:504-888-0388
Practice Address - Fax:504-888-9119
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11984R207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1483958Medicaid
LA5H136CM01Medicare PIN
LAH11206Medicare UPIN