Provider Demographics
NPI:1821279845
Name:DARTEZ, DENNY JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DENNY
Middle Name:JAMES
Last Name:DARTEZ
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 919112
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9112
Mailing Address - Country:US
Mailing Address - Phone:337-439-4706
Mailing Address - Fax:337-439-8110
Practice Address - Street 1:1800 RYAN ST STE 105
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6078
Practice Address - Country:US
Practice Address - Phone:337-439-4706
Practice Address - Fax:337-439-8110
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL288382085B0100X
390200000X
LA2053442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL128973Medicaid
AL128974Medicaid
AL129024Medicaid
AL129165Medicaid
AL051117775OtherBCBS
AL051117782OtherBCBS
AL051117778OtherBCBS
AL051117779OtherBCBS
AL051117784OtherBCBS
MS09386221Medicaid
AL129060Medicaid
AL129099Medicaid
AL051117776OtherBCBS
AL051117780OtherBCBS
AL129164Medicaid
AL051117781OtherBCBS
AL051117783OtherBCBS
AL129026Medicaid
AL051117777OtherBCBS
AL129096Medicaid
AL129059Medicaid
AL129099Medicaid