Healthcare Provider Details

I. General information

NPI: 1467541797
Provider Name (Legal Business Name): CARTER DAVID PADDOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 RIVERSIDE DR SUITE 230
METAIRIE LA
70003
US

IV. Provider business mailing address

6640 RIVERSIDE DR SUITE 230
METAIRIE LA
70003-7102
US

V. Phone/Fax

Practice location:
  • Phone: 504-889-1831
  • Fax:
Mailing address:
  • Phone: 504-889-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number012313
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: