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General NPI Number Information
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NPI Number | 1538151451
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Entity Type | Individual
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Provider Name | EDWARD W DAUTERIVE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1100 ANDRE ST
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City | NEW IBERIA
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State | LA
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Zip | 70563-2159
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Country | US
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Telephone | 337-369-9309
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Fax | 337-365-8455
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Provider Business Mailing Address
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Address Line | 1100 ANDRE ST. STE. 101
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City | NEW IBERIA
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State | LA
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Zip | 70563-2159
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Country | US
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Telephone | 337-369-9309
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Fax | 337-365-8455
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 014729
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 014729
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License Number State | LA
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