Healthcare Provider Details

I. General information

NPI: 1609034800
Provider Name (Legal Business Name): DAVID V. MARAIST JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2008
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 SOUTH UNION
OPELOUSAS LA
70570
US

IV. Provider business mailing address

P.O. BOX 159
OPELOUSAS LA
70571
US

V. Phone/Fax

Practice location:
  • Phone: 337-942-7567
  • Fax: 337-948-4993
Mailing address:
  • Phone: 337-942-7567
  • Fax: 337-948-4993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberDPM.200012
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: