Provider Demographics
NPI:1235125733
Name:DELOACH, STEVEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:DELOACH
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 1:1224 SAINT CHARLES AVE
Mailing Address - Street 2:1-C
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4334
Mailing Address - Country:US
Mailing Address - Phone:504-301-1670
Mailing Address - Fax:
Practice Address - Street 1:1224 SAINT CHARLES AVE
Practice Address - Street 2:1-C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-4334
Practice Address - Country:US
Practice Address - Phone:504-301-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1422941Medicaid
LAH91012Medicare UPIN
LA4F354Medicare ID - Type Unspecified