Provider Demographics
NPI:1881627719
Name:WELLMEYER, DAVID MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:WELLMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-1332
Mailing Address - Fax:985-230-1334
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-1682
Practice Address - Fax:985-230-1617
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.019167207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09005712Medicaid
930092894OtherRR MEDICARE NUMBER
LA1367125Medicaid
930092894OtherRR MEDICARE NUMBER
54070Medicare ID - Type Unspecified