Provider Demographics
NPI:1528034394
Name:DOUCET, DAVID JAMES (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:DOUCET
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SAINT MARY PL
Mailing Address - Street 2:PFS - PRO BILLING
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4343
Mailing Address - Country:US
Mailing Address - Phone:318-681-6878
Mailing Address - Fax:318-681-7402
Practice Address - Street 1:1 SAINT MARY PL
Practice Address - Street 2:PFS - PRO BILLING
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4343
Practice Address - Country:US
Practice Address - Phone:318-681-6878
Practice Address - Fax:318-681-7402
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA037606163W00000X
LAAP037606367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1960438Medicaid
LA59925Medicare PIN