Healthcare Provider Details

I. General information

NPI: 1598801243
Provider Name (Legal Business Name): HERSHEL DALE MEADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 CHISUM STREET
SICILY ISLAND LA
71368-0008
US

IV. Provider business mailing address

PO BOX 8 307 CHISUM STREET
SICILY ISLAND LA
71368-0008
US

V. Phone/Fax

Practice location:
  • Phone: 318-389-5727
  • Fax: 318-389-4028
Mailing address:
  • Phone: 318-389-5727
  • Fax: 318-389-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD 024332
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: