Provider Demographics
NPI:1679550248
Name:MCCANN, DARRON CLARK (MD)
Entity Type:Individual
Prefix:
First Name:DARRON
Middle Name:CLARK
Last Name:MCCANN
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 1:424 N WASHINGTON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2426
Mailing Address - Country:US
Mailing Address - Phone:318-253-1788
Mailing Address - Fax:318-253-1787
Practice Address - Street 1:424 N WASHINGTON ST
Practice Address - Street 2:STE 2
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2426
Practice Address - Country:US
Practice Address - Phone:318-253-1788
Practice Address - Fax:318-253-1787
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1487155Medicaid
LA5H245Medicare PIN
H13591Medicare UPIN