Provider Demographics
NPI:1518912864
Name:MCDAVID, ANTHONY E (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:MCDAVID
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 1:101 JUDGE TANNER BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7503
Mailing Address - Country:US
Mailing Address - Phone:985-809-5800
Mailing Address - Fax:
Practice Address - Street 1:101 JUDGE TANNER BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7503
Practice Address - Country:US
Practice Address - Phone:985-809-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87347208000000X
LAMD.205169208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02279234Medicaid
FL267421100Medicaid
LA1741639Medicaid
LA5Q9837061Medicare PIN
FL788062Medicare ID - Type Unspecified
LA1741639Medicaid