Provider Demographics
NPI:1790717601
Name:DRAGON, DAVID M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:DRAGON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6220 PERKINS ROAD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4120
Mailing Address - Country:US
Mailing Address - Phone:225-768-7777
Mailing Address - Fax:225-214-3400
Practice Address - Street 1:6220 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4120
Practice Address - Country:US
Practice Address - Phone:225-768-7777
Practice Address - Fax:225-214-3400
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015650174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1347167Medicaid
LA5C951Medicare ID - Type UnspecifiedGROUP NUMBER
LA1347167Medicaid
LA5L925Medicare ID - Type Unspecified