1962589200 NPI number — DR. STEVE J. WATSON &DR. WILLIAM H. DABDOUB, APMC

Table of content: (NPI 1962589200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962589200 NPI number — DR. STEVE J. WATSON &DR. WILLIAM H. DABDOUB, APMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. STEVE J. WATSON &DR. WILLIAM H. DABDOUB, APMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASSOCIATED FOOT SURGEONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962589200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 SMART PL
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
SLIDELL
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70458-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-649-0002
Provider Business Mailing Address Fax Number:
985-649-0034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 SMART PL
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SLIDELL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70458-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
985-649-0002
Provider Business Practice Location Address Fax Number:
985-649-0034
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUGAS
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
985-649-0002

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PD024R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1318418 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CN3638 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: CN3639 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: CN3640 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1318400 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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