Basic Information
| Provider Information | |||||||||
| NPI: | 1598935314 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROWELL | ||||||||
| FirstName: | CURTIS | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1812 NEYREY DR | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700012612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049060673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4300 HOUMA BLVD FL 6 | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045034331 | ||||||||
| FaxNumber: | 5045034341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2008 | ||||||||
| LastUpdateDate: | 05/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | PGY.2.LSUN-IM | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD.202723 | LA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 1507750 | 05 | LA | MEDICAID |