Basic Information
| Provider Information | |||||||||
| NPI: | 1356363428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAUPHIN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | CEDRIC | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 DULLES DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705063008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372625870 | ||||||||
| FaxNumber: | 3372621272 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 MARTIN LUTHER KING JR DR | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 705011884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372332437 | ||||||||
| FaxNumber: | 3373233397 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0401X | 13353 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207RA0401X | MD.013353 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Addiction Medicine |
No ID Information.