Provider Demographics
NPI:1609034800
Name:MARAIST, DAVID V JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:V
Last Name:MARAIST
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 159
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571
Mailing Address - Country:US
Mailing Address - Phone:337-942-7567
Mailing Address - Fax:337-948-4993
Practice Address - Street 1:2848 SOUTH UNION
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-942-7567
Practice Address - Fax:337-948-4993
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200012213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1150100Medicaid
LA4N3067191Medicare PIN
LA1150100Medicaid