Provider Demographics
NPI:1689673667
Name:PACE, DAVID J (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:PACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 LINE AVE
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2128
Mailing Address - Country:US
Mailing Address - Phone:318-221-2225
Mailing Address - Fax:318-459-2955
Practice Address - Street 1:2225 LINE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2128
Practice Address - Country:US
Practice Address - Phone:318-221-2225
Practice Address - Fax:318-459-2955
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023182208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1495212Medicare ID - Type Unspecified