Healthcare Provider Details

I. General information

NPI: 1558361865
Provider Name (Legal Business Name): RANDY JAMES DAIGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 NAPOLEON AVE
SUNSET LA
70584-6100
US

IV. Provider business mailing address

990 NAPOLEON AVE
SUNSET LA
70584-6100
US

V. Phone/Fax

Practice location:
  • Phone: 337-662-5248
  • Fax: 337-662-5391
Mailing address:
  • Phone: 337-662-5248
  • Fax: 337-662-5391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number023059
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: