Provider Demographics
NPI:1972598712
Name:ALTAMIRANO, DODANIM FRANCISCO (MD)
Entity Type:Individual
Prefix:MR
First Name:DODANIM
Middle Name:FRANCISCO
Last Name:ALTAMIRANO
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 1:504 JACK MILLER RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:VILLE PLATTE
Mailing Address - State:LA
Mailing Address - Zip Code:70586-5600
Mailing Address - Country:US
Mailing Address - Phone:337-363-3560
Mailing Address - Fax:337-363-3507
Practice Address - Street 1:504 JACK MILLER RD
Practice Address - Street 2:SUITE 3
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-5600
Practice Address - Country:US
Practice Address - Phone:337-363-3560
Practice Address - Fax:337-363-3507
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11525R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1671177Medicaid
BA2799320OtherDEA
BA2799320OtherDEA
LA1671177Medicaid