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Contact Information

FIDENCIO H DAVALOS, MD
2770 3RD AVE STE 350
LAKE CHARLES, LA70601-0404
 Phone: 337-494-2750
 Fax: 337-494-2760
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Critical Care Medicine

207RC0200X 11 Physician/Internal Medicine
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for FIDENCIO H DAVALOS · (Male)

NPI Number 1265872725
Status Active
Credentials MD
Entity Individual
Enumeration date 06/28/2013
Last updated 03/16/2022 - About 4 years ago
Sole proprietor 1 Yes
Identifiers
  • LA License # 322076
  • NM License # MD2017-0687
  • NY License # 287474
  • LA Medicaid 2528696
  • LA Other MD.322076 STATE MEDICAL LICENSE
Hospital affiliation(s)
  • LAKE CHARLES MEMORIAL HOSPITAL - (Acute Care)
    1701 OAK PARK BLVD
    LAKE CHARLES, LA 70601
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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