Healthcare Provider Details

I. General information

NPI: 1033150784
Provider Name (Legal Business Name): TODD A DEVALCOURT P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 W CONGRESS ST STE 3100
LAFAYETTE LA
70506-6771
US

IV. Provider business mailing address

PO BOX 919229
DALLAS TX
75391-9229
US

V. Phone/Fax

Practice location:
  • Phone: 337-703-3201
  • Fax: 337-703-3202
Mailing address:
  • Phone: 337-703-3201
  • Fax: 337-703-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberP.A.A10538
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: