Provider Demographics
NPI:1265460471
Name:DECUIR, ANTHONY (DPM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DECUIR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7434 PICARDY AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4331
Mailing Address - Country:US
Mailing Address - Phone:225-757-8808
Mailing Address - Fax:225-757-8875
Practice Address - Street 1:7434 PICARDY AVE
Practice Address - Street 2:SUIET A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4331
Practice Address - Country:US
Practice Address - Phone:225-757-8808
Practice Address - Fax:225-757-8875
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD0112213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1116106Medicaid
4A691Medicare ID - Type Unspecified
P00117063Medicare ID - Type UnspecifiedMEDICARE RAIL ROAD
LA1116106Medicaid