Provider Demographics
NPI:1831314905
Name:CHIVERTON, JAMES ALFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALFRED
Last Name:CHIVERTON
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 1:4933 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-1031
Mailing Address - Country:US
Mailing Address - Phone:504-780-2766
Mailing Address - Fax:504-218-4607
Practice Address - Street 1:4933 WABASH ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1031
Practice Address - Country:US
Practice Address - Phone:504-780-2766
Practice Address - Fax:504-218-4607
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA022226208D00000X
LAMD.022226207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1496367Medicaid
LAG54100Medicare UPIN
LA5Y677Medicare ID - Type Unspecified
LA1496367Medicaid