Provider Demographics
NPI:1518954833
Name:REMEDIOS, DAVID MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MANUEL
Last Name:REMEDIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6212 GRAND OAK DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2336
Mailing Address - Country:US
Mailing Address - Phone:318-487-1401
Mailing Address - Fax:
Practice Address - Street 1:5615 JACKSON STREET EXT
Practice Address - Street 2:BLDG E
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2326
Practice Address - Country:US
Practice Address - Phone:318-442-6989
Practice Address - Fax:318-442-7123
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA08892R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1923036Medicaid
LA1923036Medicaid
LAE92346Medicare UPIN