Provider Demographics
NPI:1275595589
Name:EDDY, JAMES HARVEY III (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HARVEY
Last Name:EDDY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4840
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4840
Mailing Address - Country:US
Mailing Address - Phone:337-477-9019
Mailing Address - Fax:337-478-1290
Practice Address - Street 1:215 W PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8450
Practice Address - Country:US
Practice Address - Phone:337-477-9019
Practice Address - Fax:337-478-1290
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2012-10-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA016824207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355186Medicaid
LA1355186Medicaid
LAB65119Medicare UPIN