Provider Demographics
NPI:1356447635
Name:DEPAULA, JOHN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:DEPAULA
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 1:4315 HOUMA BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2943
Mailing Address - Country:US
Mailing Address - Phone:504-455-4622
Mailing Address - Fax:504-455-4688
Practice Address - Street 1:4315 HOUMA BLVD STE 201
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2943
Practice Address - Country:US
Practice Address - Phone:504-455-4622
Practice Address - Fax:504-455-4688
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202786207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1882127Medicaid
LA4M140CT87Medicare PIN