Provider Demographics
NPI:1164859047
Name:DAMON T CUDIHY MD LLC
Entity Type:Organization
Organization Name:DAMON T CUDIHY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:T
Authorized Official - Last Name:CUDIHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-261-5433
Mailing Address - Street 1:1211 COOLIDGE BLVD
Mailing Address - Street 2:STE 403
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2636
Mailing Address - Country:US
Mailing Address - Phone:337-261-5433
Mailing Address - Fax:337-269-9652
Practice Address - Street 1:1211 COOLIDGE BLVD
Practice Address - Street 2:STE 403
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2636
Practice Address - Country:US
Practice Address - Phone:337-261-5433
Practice Address - Fax:337-269-9652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD206213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2341227Medicaid