Provider Demographics
NPI:1477619260
Name:INTERNAL MEDICINE ASSOCIATES OF HOUMA
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF HOUMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULES
Authorized Official - Middle Name:S
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-223-0423
Mailing Address - Street 1:855 BELANGER STREET
Mailing Address - Street 2:SUITE 102 104
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360
Mailing Address - Country:US
Mailing Address - Phone:985-223-0423
Mailing Address - Fax:985-876-4599
Practice Address - Street 1:855 BELANGER STREET
Practice Address - Street 2:SUITE 102 104
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360
Practice Address - Country:US
Practice Address - Phone:985-223-0423
Practice Address - Fax:985-876-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1442704Medicaid
LA1442704Medicaid