Provider Demographics
NPI:1376539171
Name:MCGINTY, DALE P (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:P
Last Name:MCGINTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 650
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-798-6984
Mailing Address - Fax:318-221-2184
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 650
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-798-6984
Practice Address - Fax:318-221-2184
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA05375R207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1319881Medicaid
B89163Medicare UPIN
LA1319881Medicaid
LA5L440Medicare PIN