Provider Demographics
NPI:1801852207
Name:WARE, DAVID BENJAMIN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BENJAMIN
Last Name:WARE
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 1:281 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3638
Mailing Address - Country:US
Mailing Address - Phone:337-457-2200
Mailing Address - Fax:337-457-2203
Practice Address - Street 1:281 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3638
Practice Address - Country:US
Practice Address - Phone:337-457-2200
Practice Address - Fax:337-457-2203
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14666R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1123153Medicaid
LA4E442CC49OtherMEDICARE ID
H33310Medicare UPIN