Healthcare Provider Details

I. General information

NPI: 1669409199
Provider Name (Legal Business Name): DR DOUGLAS MEHAFFIE MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 WALL BLVD
GRETNA LA
70056-7107
US

IV. Provider business mailing address

148 WALL BLVD
GRETNA LA
70056-7107
US

V. Phone/Fax

Practice location:
  • Phone: 504-393-2775
  • Fax: 504-393-2744
Mailing address:
  • Phone: 504-393-2775
  • Fax: 504-393-2744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS MEHAFFIE
Title or Position: OWNER
Credential: MD
Phone: 504-393-2775