MEDICARE: DAVID MICHAEL THERIOT 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	2085N0700X	Neuroradiology Physician	320813	LA
2	2085R0202X	Diagnostic Radiology Physician	320813	LA

General Provider Information

NPI Number	:	1821400904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MICHAEL THERIOT M.D.

Provider Business Mailing Address
First Line	:	1111 MEDICAL CENTER BLVD STE 108
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3152
Country	:	US
Telephone Number	:	504-349-1461
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 MEDICAL CENTER BLVD STE 108
Second Line	:
City	:	MARRERO
State	:	LA
Zip	:	70072-3152
Country	:	US
Telephone Number	:	504-349-1461
Fax Number	:

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

Provider Enumeration Date	:	05/23/2014
Last Update Date	:	06/09/2020

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