Provider Demographics
NPI:1871193540
Name:MALVEAUX, DUDLEY PAUL III
Entity Type:Individual
Prefix:MR
First Name:DUDLEY
Middle Name:PAUL
Last Name:MALVEAUX
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 ULLOA ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6746
Mailing Address - Country:US
Mailing Address - Phone:504-915-9974
Mailing Address - Fax:
Practice Address - Street 1:3606 DESIRE PKWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70126
Practice Address - Country:US
Practice Address - Phone:504-915-9974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA007383418172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver