Provider Demographics
NPI:1356846778
Name:JENNEMAN, DAKOTA FREDERICK (DO)
Entity type:Individual
Prefix:
First Name:DAKOTA
Middle Name:FREDERICK
Last Name:JENNEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-0014
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:4809 AMBASSADOR CAFFERY PKWY STE 230
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-8800
Practice Address - Country:US
Practice Address - Phone:337-470-0014
Practice Address - Fax:337-470-6495
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-02475207RH0003X, 207R00000X
LA343254207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine