Provider Demographics
NPI:1962493999
Name:JAMES P. DAVID, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAMES P. DAVID, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:VASCULAR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VASCULAR SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-445-0058
Mailing Address - Street 1:105 YORKTOWN DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3621
Mailing Address - Country:US
Mailing Address - Phone:318-445-0058
Mailing Address - Fax:318-484-9475
Practice Address - Street 1:105 YORKTOWN DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3621
Practice Address - Country:US
Practice Address - Phone:318-445-0058
Practice Address - Fax:318-484-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1132560Medicaid
LA5L063Medicare PIN