Provider Demographics
NPI:1497717656
Name:DIGIGLIA, JOHN A III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:DIGIGLIA
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8258
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:4150 NELSON RD STE E5
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4133
Practice Address - Country:US
Practice Address - Phone:337-474-7290
Practice Address - Fax:337-477-4674
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2021-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA19034207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1018163Medicaid
533857460Medicare PIN
080170434Medicare PIN
B64579Medicare UPIN