Provider Demographics
NPI:1326098062
Name:MACE, JAMES E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:MACE
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 1:1203 S TYLER ST
Mailing Address - Street 2:STE E
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2353
Mailing Address - Country:US
Mailing Address - Phone:985-871-6020
Mailing Address - Fax:985-871-6027
Practice Address - Street 1:1203 S TYLER ST
Practice Address - Street 2:STE E
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2353
Practice Address - Country:US
Practice Address - Phone:985-871-6020
Practice Address - Fax:985-871-6027
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.018647207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1903787Medicaid
LA5N238Medicare ID - Type Unspecified
E52089Medicare UPIN