Provider Demographics
NPI:1720222961
Name:DALY, DAVID D JR (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:DALY
Suffix:JR
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 1:213 RUE FONTAINE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5742
Mailing Address - Country:US
Mailing Address - Phone:337-269-9777
Mailing Address - Fax:337-269-0244
Practice Address - Street 1:315 RUE LOUIS XIV BLDG B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5734
Practice Address - Country:US
Practice Address - Phone:337-269-9777
Practice Address - Fax:337-269-0244
Is Sole Proprietor?:No
Enumeration Date:2009-04-30
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA305032207RC0000X, 207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2444387Medicaid