Provider Demographics
NPI:1922007491
Name:DANTONI, JAMES (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DANTONI
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 1:17609 OLD JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3979
Mailing Address - Country:US
Mailing Address - Phone:225-677-9595
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:17609 OLD JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3979
Practice Address - Country:US
Practice Address - Phone:225-677-9595
Practice Address - Fax:225-644-5213
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA23058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490032Medicaid
LA5E912Medicare PIN
LAH06706Medicare UPIN