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General NPI Number Information
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NPI Number | 1740577998
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Entity Type | Individual
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Provider Name | JEFFREY JOHN DAIGLE P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2011
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Last Update Date | 12/27/2019
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Provider Practice Location Address
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Address Line | 1615 WOLF CIR
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City | LAKE CHARLES
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State | LA
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Zip | 70605-2348
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Country | US
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Telephone | 337-312-8681
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Fax | 337-312-8682
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Provider Business Mailing Address
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Address Line | 501 DR MICHAEL DEBAKEY DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5724
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Country | US
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Telephone | 337-312-8258
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Fax | 337-312-6708
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA200462
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License Number State | LA
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