Provider Demographics
NPI:1225081755
Name:MACMURDO, HAL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:HAL
Middle Name:DAVID
Last Name:MACMURDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N UNION ST
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6313
Mailing Address - Country:US
Mailing Address - Phone:337-948-1444
Mailing Address - Fax:337-948-0065
Practice Address - Street 1:823 N UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6313
Practice Address - Country:US
Practice Address - Phone:337-948-1444
Practice Address - Fax:337-948-0065
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD021265208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1663883Medicaid
LA1663883Medicaid
LA5W333Medicare ID - Type Unspecified