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General NPI Number Information
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NPI Number | 1295895068
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Entity Type | Organization
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Legal Business Name | D LOUIS M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 350 30TH STREET SUITE 540
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City | OAKLAND
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State | CA
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Zip | 94609-3487
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Country | US
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Telephone | 510-836-0223
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Fax | 510-836-8791
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Provider Business Mailing Address
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Address Line | 350 30TH STREET SUITE 540
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City | OAKLAND
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State | CA
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Zip | 94609-3487
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Country | US
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Telephone | 510-836-0223
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Fax | 510-836-8791
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID LOUIS
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Credential | M.D.
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Telephone | 510-836-0223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G39231
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License Number State | CA
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