Provider Demographics
NPI:1487201562
Name:DANGERFIELD, WILBERT
Entity Type:Individual
Prefix:MR
First Name:WILBERT
Middle Name:
Last Name:DANGERFIELD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RUE DE LA PAIX
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5316
Mailing Address - Country:US
Mailing Address - Phone:985-510-1359
Mailing Address - Fax:
Practice Address - Street 1:2900 WESTFORK DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70827-0010
Practice Address - Country:US
Practice Address - Phone:985-510-1359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)