Provider Demographics
NPI:1942269758
Name:MCLURKIN, DANIELLE LAVONNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:LAVONNE
Last Name:MCLURKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 RYAN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-2820
Mailing Address - Country:US
Mailing Address - Phone:337-915-0691
Mailing Address - Fax:877-706-9899
Practice Address - Street 1:4050 RYAN ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-2820
Practice Address - Country:US
Practice Address - Phone:337-915-0691
Practice Address - Fax:877-706-9899
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15205R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1162965Medicaid
LAH98575Medicare UPIN