Healthcare Provider Details

I. General information

NPI: 1760706782
Provider Name (Legal Business Name): MCCALL G MCDANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71211 HIGHWAY 21
COVINGTON LA
70433-7121
US

IV. Provider business mailing address

PO BOX 54482 ATTN: MANAGED CARE DEPARTMENT
NEW ORLEANS LA
70154-4482
US

V. Phone/Fax

Practice location:
  • Phone: 985-893-9922
  • Fax:
Mailing address:
  • Phone: 985-898-4493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number206355
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: