Provider Demographics
NPI:1356363428
Name:DAUPHIN, JOHN CEDRIC (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CEDRIC
Last Name:DAUPHIN
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 1:302 DULLES DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3008
Mailing Address - Country:US
Mailing Address - Phone:337-262-5870
Mailing Address - Fax:337-262-1272
Practice Address - Street 1:809 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-1884
Practice Address - Country:US
Practice Address - Phone:337-233-2437
Practice Address - Fax:337-323-3397
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13353207QA0401X
LAMD.013353207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA51858Medicare ID - Type Unspecified