Provider Demographics
NPI:1679844369
Name:DAVID STEPHEN DAWES, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAVID STEPHEN DAWES, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HULIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-534-4548
Mailing Address - Street 1:850 KALISTE SALOOM RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-4230
Mailing Address - Country:US
Mailing Address - Phone:337-534-4548
Mailing Address - Fax:337-534-0798
Practice Address - Street 1:850 KALISTE SALOOM RD
Practice Address - Street 2:SUITE 108
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-4230
Practice Address - Country:US
Practice Address - Phone:337-534-4548
Practice Address - Fax:337-534-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0201222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1931721Medicaid
LA5R049Medicare UPIN