Healthcare Provider Details

I. General information

NPI: 1679844369
Provider Name (Legal Business Name): DAVID STEPHEN DAWES, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KALISTE SALOOM RD SUITE 108
LAFAYETTE LA
70508-4230
US

IV. Provider business mailing address

850 KALISTE SALOOM RD SUITE 108
LAFAYETTE LA
70508-4230
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-4548
  • Fax: 337-534-0798
Mailing address:
  • Phone: 337-534-4548
  • Fax: 337-534-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number020122
License Number StateLA

VIII. Authorized Official

Name: MRS. DANA MICHELLE HULIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 337-534-4548