Provider Demographics
NPI:1538123534
Name:DAVIS, PAUL MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:DAVIS
Suffix:JR
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 1:1200 LAWRENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT GABRIEL
Mailing Address - State:LA
Mailing Address - Zip Code:70776-5119
Mailing Address - Country:US
Mailing Address - Phone:225-642-6989
Mailing Address - Fax:225-642-6919
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:SUITE 1008
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-766-0416
Practice Address - Fax:225-769-9212
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1256R2086S0129X
MS279482086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120843Medicaid
LA1544752Medicaid
LA5A627Medicare ID - Type UnspecifiedLA MEDICARE NUMBER
MS00120843Medicaid