Provider Demographics
NPI:1710341219
Name:JOHNSON-PETERS, DEMARCQUANAEE (MD)
Entity Type:Individual
Prefix:
First Name:DEMARCQUANAEE
Middle Name:
Last Name:JOHNSON-PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEMARCQUANAEE
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:526 PARK PLACE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3946
Mailing Address - Country:US
Mailing Address - Phone:225-241-1119
Mailing Address - Fax:318-441-1050
Practice Address - Street 1:526 PARK PLACE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3946
Practice Address - Country:US
Practice Address - Phone:225-241-1119
Practice Address - Fax:318-441-1050
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA302773207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine