Healthcare Provider Details

I. General information

NPI: 1760489728
Provider Name (Legal Business Name): DAVID E ALLIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WILSON ST STE C
LAFAYETTE LA
70503-2439
US

IV. Provider business mailing address

PO BOX 70
MILTON LA
70558
US

V. Phone/Fax

Practice location:
  • Phone: 337-456-6523
  • Fax: 337-456-6521
Mailing address:
  • Phone: 337-456-6523
  • Fax: 337-456-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number07649R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: