Provider Demographics
NPI:1598891806
Name:DOAN, DAVID MALCOM (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MALCOM
Last Name:DOAN
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:BOX 2459
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2459
Mailing Address - Country:US
Mailing Address - Phone:985-345-3402
Mailing Address - Fax:985-345-8575
Practice Address - Street 1:15814 PROFESSIONAL PLAZA
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1453
Practice Address - Country:US
Practice Address - Phone:985-345-3402
Practice Address - Fax:985-345-8575
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-09-05
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-09-05
Provider Licenses
StateLicense IDTaxonomies
LA10302207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1132314Medicaid
LAB63063Medicare UPIN
LA51434Medicare ID - Type UnspecifiedENT FACIAL PLASTIC SURG