Healthcare Provider Details

I. General information

NPI: 1396906087
Provider Name (Legal Business Name): RONALD J DAIGLE, MD, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL DR SUITE 404
LAFAYETTE LA
70503-2852
US

IV. Provider business mailing address

155 HOSPITAL DR SUITE 404
LAFAYETTE LA
70503-2852
US

V. Phone/Fax

Practice location:
  • Phone: 337-232-5954
  • Fax: 337-235-5807
Mailing address:
  • Phone: 337-232-5954
  • Fax: 337-235-5807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number15130
License Number StateLA

VIII. Authorized Official

Name: DR. RONALD JOSEPH DAIGLE
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 337-232-5954