=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629076575
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEVINDER KUMAR VERMA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2005
-----------------------------------------------------
Last Update Date | 12/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3330 MASONIC DRIVE
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-449-2673
-----------------------------------------------------
Fax | 318-449-2320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3330 MASONIC DRIVE
-----------------------------------------------------
City | ALEXANDRIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71301-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-449-2673
-----------------------------------------------------
Fax | 318-449-2320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 12284R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | MD.12284R
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------