Provider Demographics
NPI:1760489728
Name:ALLIE, DAVID E (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:ALLIE
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:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:LA
Mailing Address - Zip Code:70558
Mailing Address - Country:US
Mailing Address - Phone:337-456-6523
Mailing Address - Fax:337-456-6521
Practice Address - Street 1:901 WILSON ST STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2439
Practice Address - Country:US
Practice Address - Phone:337-456-6523
Practice Address - Fax:337-456-6521
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07649R208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1376060Medicaid
LA330004199OtherRR MEDICARE
LA330004199OtherRR MEDICARE
LA54402DG67Medicare PIN