Provider Demographics
NPI:1417042706
Name:HONTAS, MARK JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:HONTAS
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 1:71211 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7173
Mailing Address - Country:US
Mailing Address - Phone:985-893-9922
Mailing Address - Fax:985-892-3806
Practice Address - Street 1:71211 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7173
Practice Address - Country:US
Practice Address - Phone:985-893-9922
Practice Address - Fax:985-892-3806
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015471207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1343943Medicaid
LA1343943Medicaid
LA5M018Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER