Healthcare Provider Details

I. General information

NPI: 1104102029
Provider Name (Legal Business Name): DUMAS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 MAGAZINE ST
NEW ORLEANS LA
70130-5045
US

IV. Provider business mailing address

2121 MAGAZINE ST
NEW ORLEANS LA
70130-5045
US

V. Phone/Fax

Practice location:
  • Phone: 504-592-9818
  • Fax: 504-525-0152
Mailing address:
  • Phone: 504-592-9818
  • Fax: 504-525-0152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number025449
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number025449
License Number StateLA

VIII. Authorized Official

Name: JEREMY GERARD DUMAS
Title or Position: PHYSICIAN
Credential: MD
Phone: 504-592-9818