Provider Demographics
NPI:1720078603
Name:ZITMAN, DAWN (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:ZITMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 S BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4632
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-644-9286
Practice Address - Street 1:1937 S BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4632
Practice Address - Country:US
Practice Address - Phone:225-765-5500
Practice Address - Fax:225-644-9286
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15761R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1465607Medicaid
I26266Medicare UPIN
LA1465607Medicaid