Provider Demographics
NPI:1881668390
Name:FLETCHER, DENNIS (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:FLETCHER
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 1:2000 OPELOUSAS ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-2641
Mailing Address - Country:US
Mailing Address - Phone:337-439-9983
Mailing Address - Fax:337-310-1161
Practice Address - Street 1:2000 OPELOUSAS ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-2641
Practice Address - Country:US
Practice Address - Phone:337-439-9983
Practice Address - Fax:337-310-1161
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016826174400000X
LAMD.016826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1347990Medicaid
LA5M529OtherLA MEDICARE ID NUMBER-CHRISTUS ST PATRICK PHYSICAN GROUP PROVIDER ID#
LA5M529CE88Medicare PIN
LA1347990Medicaid
LA342042YJBAMedicare PIN
LA5M529OtherLA MEDICARE ID NUMBER-CHRISTUS ST PATRICK PHYSICAN GROUP PROVIDER ID#