Provider Demographics
NPI:1245426774
Name:DENNIS, PATRICK MICHAEL (MD)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:MICHAEL
Last Name:DENNIS
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 1:826 HARRISON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124
Mailing Address - Country:US
Mailing Address - Phone:504-309-7108
Mailing Address - Fax:504-309-7115
Practice Address - Street 1:826 HARRISON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124
Practice Address - Country:US
Practice Address - Phone:504-309-7108
Practice Address - Fax:504-309-7115
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200267207PE0004X
LAMD.200267207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09529568Medicaid
LA1063665Medicaid
LA4N049Medicare PIN
MS09529568Medicaid