1750579306 NPI number — MALCOLM J. DUGAS JR.

Table of content: (NPI 1750579306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750579306 NPI number — MALCOLM J. DUGAS JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MALCOLM J. DUGAS JR.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1750579306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 20355
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUMA
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70360-0355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-209-1974
Provider Business Mailing Address Fax Number:
985-872-4707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 BAYOU GARDENS BLVD.
Provider Second Line Business Practice Location Address:
SUITE K-4
Provider Business Practice Location Address City Name:
HOUMA
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70364-1420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-209-1974
Provider Business Practice Location Address Fax Number:
985-872-4707
Provider Enumeration Date:
10/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DUGAS
Authorized Official First Name:
MALCOLM
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
THERIPIST
Authorized Official Telephone Number:
985-209-1974

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  4615 , 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)





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