Provider Demographics
NPI:1821049743
Name:ELIAS, DAVID WADIE (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WADIE
Last Name:ELIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-0028
Mailing Address - Country:US
Mailing Address - Phone:985-492-1200
Mailing Address - Fax:985-492-1212
Practice Address - Street 1:726 N ACADIA RD
Practice Address - Street 2:SUITE 1000
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-5009
Practice Address - Country:US
Practice Address - Phone:985-625-2200
Practice Address - Fax:985-625-2206
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA201587207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA201587OtherLA. MEDICAL LIC
I64291Medicare UPIN