Provider Demographics
NPI:1467458927
Name:FAKIER, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:FAKIER
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 1:906 PICHELOUP PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3822
Mailing Address - Country:US
Mailing Address - Phone:985-804-3112
Mailing Address - Fax:
Practice Address - Street 1:906 PICHELOUP PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-3822
Practice Address - Country:US
Practice Address - Phone:985-804-3112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0189332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1071748OtherWV WORKERS COMP
VA1467458927Medicaid
TX211195701OtherTPI
VA3810010518OtherMEDICAID WV
KY000000548194OtherANTHEM-KCR
PA1563209OtherGATEWAY
PA101918790OtherMEDICAL ASSISTANCE PA
PA1019187900001Medicaid
LA1909173Medicaid
PA219107OtherUNISON
KY91729OtherSIHO-KCR
NY02880871OtherNY MEDICAL ASSISTANCE
OH2750303OtherOH MEDICAL ASSISTANCE
PA101918790Medicaid
VAP00405860OtherMEDICARE RAILROAD
PA1564931OtherAETNA
KY50017540OtherPASSPORT-KCR
OH2750303Medicaid
KY3425392000OtherPASSPORT ADVANTAGE
PA705750OtherBLUE SHIELD
KY7100028580Medicaid
KY3323286Medicare PIN
VA3810010518OtherMEDICAID WV
KY3425392000OtherPASSPORT ADVANTAGE
8L24014Medicare PIN
VAP00405860OtherMEDICARE RAILROAD
VA1467458927Medicaid
KY7100028580Medicaid
KY593615Medicare PIN
KY0998898Medicare PIN
PA219107OtherUNISON
PA1563209OtherGATEWAY
WV1071748OtherWV WORKERS COMP
PA112336Medicare PIN
PA112336-FLTMedicare PIN
OHFA7375331Medicare PIN