Provider Demographics
NPI:1275061491
Name:DAIGREPONT, DEANNA JOY (MD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:JOY
Last Name:DAIGREPONT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 122539
Mailing Address - Street 2:DEPT 2539
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2539
Mailing Address - Country:US
Mailing Address - Phone:337-494-2772
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1890 W. GAUTHIER RD
Practice Address - Street 2:STE 155
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-480-5550
Practice Address - Fax:337-480-5568
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA390200000X
LA324915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program