1033150784 NPI number — TODD A DEVALCOURT P.A.

Table of content: TODD A DEVALCOURT P.A. (NPI 1033150784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033150784 NPI number — TODD A DEVALCOURT P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEVALCOURT
Provider First Name:
TODD
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033150784
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 919229
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75391-9229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-703-3201
Provider Business Mailing Address Fax Number:
337-703-3202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4212 W CONGRESS ST STE 3100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-6771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-703-3201
Provider Business Practice Location Address Fax Number:
337-703-3202
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  P.A.A10538 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00249834 . This is a "RAILROAD" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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