Provider Demographics
NPI:1235366089
Name:PAIGE, DENTON L (PA)
Entity Type:Individual
Prefix:
First Name:DENTON
Middle Name:L
Last Name:PAIGE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 BAYOU GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-7411
Mailing Address - Country:US
Mailing Address - Phone:985-876-5000
Mailing Address - Fax:985-876-5280
Practice Address - Street 1:327 BAYOU GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70364-7411
Practice Address - Country:US
Practice Address - Phone:985-876-5000
Practice Address - Fax:985-876-5280
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant