MEDICARE: DR. JOHN DAVID DE LAPP M.D.

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	12067R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12067R	OTHER	LA	LA STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	25774	OTHER	LA	CONTROL DANGER SUBSTANCE
4	94-3311887	OTHER		TAX ID #

General Provider Information

NPI Number	:	1346216694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID DE LAPP M.D.

Provider Business Mailing Address
First Line	:	500 S 6TH ST STE A
Second Line	:
City	:	LEESVILLE
State	:	LA
Zip	:	71446-4442
Country	:	US
Telephone Number	:	337-239-8000
Fax Number	:	337-239-8003

Provider Business Practice Location Address
First Line	:	500 S 6TH ST STE A
Second Line	:
City	:	LEESVILLE
State	:	LA
Zip	:	71446-4442
Country	:	US
Telephone Number	:	337-239-8000
Fax Number	:	337-239-8003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	06/22/2012

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