Individual
DR. FIDENCIO HERNAN DAVALOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2770 3RD AVE STE 350, LAKE CHARLES, LA 70601-0404
(337) 494-2750
(337) 494-2760
Mailing address
PO BOX 122309 DEPT 2309, DALLAS, TX 75312-0001
(337) 494-2772
(337) 494-2928
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD2017-0687
NM
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
287474
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
322076
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2528696
—
LA
01
—
MD.322076
STATE MEDICAL LICENSE
LA
Enumeration date
06/28/2013
Last updated
03/16/2022
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