Individual
EDWARD WEEKS DAUTERIVE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
58515 PEARL ACRES RD, SLIDELL, LA 70461-5423
(985) 641-8982
Mailing address
58515 PEARL ACRES RD, SLIDELL, LA 70461-5423
(985) 641-8982
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD 205027
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2106406
—
LA
Enumeration date
03/19/2010
Last updated
12/13/2016
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