Provider Demographics
NPI:1477870210
Name:IKEMIRE, PAUL AR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:AR
Last Name:IKEMIRE
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 1:111 WATER ST STE 4
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2456
Mailing Address - Country:US
Mailing Address - Phone:504-717-3050
Mailing Address - Fax:504-617-6371
Practice Address - Street 1:719 OKEEFE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1906
Practice Address - Country:US
Practice Address - Phone:504-372-2948
Practice Address - Fax:504-617-6371
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.205087208D00000X
CAC159092208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2108794Medicaid
CAC159092OtherMEDICAL BOARD OF CALIFORNIA