Provider Demographics
NPI:1598801243
Name:MEADE, HERSHEL DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:HERSHEL
Middle Name:DALE
Last Name:MEADE
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:PO BOX 8
Mailing Address - Street 2:307 CHISUM STREET
Mailing Address - City:SICILY ISLAND
Mailing Address - State:LA
Mailing Address - Zip Code:71368-0008
Mailing Address - Country:US
Mailing Address - Phone:318-389-5727
Mailing Address - Fax:318-389-4028
Practice Address - Street 1:307 CHISUM STREET
Practice Address - Street 2:
Practice Address - City:SICILY ISLAND
Practice Address - State:LA
Practice Address - Zip Code:71368-0008
Practice Address - Country:US
Practice Address - Phone:318-389-5727
Practice Address - Fax:318-389-4028
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD 024332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1574503Medicaid
LA1574503Medicaid
H46512Medicare UPIN