Healthcare Provider Details

I. General information

NPI: 1235366089
Provider Name (Legal Business Name): DENTON L PAIGE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 06/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 BAYOU GARDENS BLVD
HOUMA LA
70364-7411
US

IV. Provider business mailing address

327 BAYOU GARDENS BLVD
HOUMA LA
70364-7411
US

V. Phone/Fax

Practice location:
  • Phone: 985-876-5000
  • Fax: 985-876-5280
Mailing address:
  • Phone: 985-876-5000
  • Fax: 985-876-5280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number667
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: