Healthcare Provider Details

I. General information

NPI: 1518912864
Provider Name (Legal Business Name): ANTHONY E MCDAVID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JUDGE TANNER BLVD SUITE 302
COVINGTON LA
70433-7503
US

IV. Provider business mailing address

101 JUDGE TANNER BLVD SUITE 302
COVINGTON LA
70433-7503
US

V. Phone/Fax

Practice location:
  • Phone: 985-809-5800
  • Fax:
Mailing address:
  • Phone: 985-809-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME87347
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.205169
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: