MEDICARE: DAVID J. DREZ, JR., M.D., A MEDICAL CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	009625	LA

General Provider Information

NPI Number	:	1073900148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID J. DREZ, JR., M.D., A MEDICAL CORP

Provider Business Mailing Address
First Line	:	4700 W CYPRESS LANDING DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5978
Country	:	US
Telephone Number	:	337-824-3819
Fax Number	:	337-824-0160

Provider Business Practice Location Address
First Line	:	1 HOSPITAL DR
Second Line	:	SUITE 100
City	:	JENNINGS
State	:	LA
Zip	:	70546-3641
Country	:	US
Telephone Number	:	337-824-3819
Fax Number	:	337-824-0160

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DAVID J DREZ, JR
Credential	:	M.D.
Telephone Number	:	337-824-3819

Provider Enumeration Date	:	04/16/2015
Last Update Date	:	04/16/2015

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