Provider Demographics
NPI:1407056286
Name:LISA B DAVID MD APMC
Entity Type:Organization
Organization Name:LISA B DAVID MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-266-9820
Mailing Address - Street 1:PO BOX 80765
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70598-0765
Mailing Address - Country:US
Mailing Address - Phone:337-266-9820
Mailing Address - Fax:337-266-9822
Practice Address - Street 1:185 S BEADLE RD
Practice Address - Street 2:BLDG 2 STE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4287
Practice Address - Country:US
Practice Address - Phone:337-266-9820
Practice Address - Fax:337-266-9822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADG7830Medicare PIN
LA5BC07Medicare PIN