Healthcare Provider Details

I. General information

NPI: 1821279845
Provider Name (Legal Business Name): DENNY JAMES DARTEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RYAN ST STE 105
LAKE CHARLES LA
70601-6078
US

IV. Provider business mailing address

PO BOX 919112
DALLAS TX
75391-9112
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-4706
  • Fax: 337-439-8110
Mailing address:
  • Phone: 337-439-4706
  • Fax: 337-439-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number28838
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number205344
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: