=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891069118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DANIEL J TRAHANT, MD (APMC)
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2012
-----------------------------------------------------
Last Update Date | 03/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 HOUMA BLVD SUITE 305
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-779-6400
-----------------------------------------------------
Fax | 504-779-6405
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3901 HOUMA BLVD SUITE 305
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70006-2930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-779-6400
-----------------------------------------------------
Fax | 504-779-6405
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | LISA HAVA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 504-779-6400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 011424
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------