Provider Demographics
NPI:1972558500
Name:DABDOUB, WILLIAM H (DPM)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:H
Last Name:DABDOUB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 ROBERT BLVD STE 190
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2064
Mailing Address - Country:US
Mailing Address - Phone:985-649-0002
Mailing Address - Fax:985-649-0034
Practice Address - Street 1:1150 ROBERT BLVD STE 190
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2064
Practice Address - Country:US
Practice Address - Phone:985-649-0002
Practice Address - Fax:985-649-0034
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD024R213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSCN3639OtherRAILROAD MEDICARE
MS00116608Medicaid
LACN3638OtherRAILROAD MEDICARE
LACN3640OtherRAILROAD MEDICARE
LA1318400Medicaid
LA0533030001Medicare NSC
LA56499C213Medicare PIN
T19728Medicare UPIN
LACN3640OtherRAILROAD MEDICARE