Provider Demographics
NPI:1134317357
Name:DAVID DEBESSONET APMC
Entity Type:Organization
Organization Name:DAVID DEBESSONET APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-779-5942
Mailing Address - Street 1:PO BOX 6985
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70009-6985
Mailing Address - Country:US
Mailing Address - Phone:504-779-5942
Mailing Address - Fax:504-779-5945
Practice Address - Street 1:4315 HOUMA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2940
Practice Address - Country:US
Practice Address - Phone:504-779-5942
Practice Address - Fax:504-779-5945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD010105174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CG99Medicare PIN