Martin Joseph Degravelle, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD011998 Issued in LA

Practice address

2308 E Main St
New Iberia, LA 70560-4032

Phone

(337) 560-5005

Fax

(337) 560-9757

NPI assigned

Jun 8, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700826500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2308 E MAIN ST",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705604032",
            "telephone_number": "337-560-5005",
            "fax_number": "337-560-9757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2308 E MAIN ST",
            "city": "NEW IBERIA",
            "state": "LA",
            "postal_code": "705604032",
            "telephone_number": "337-560-5005",
            "fax_number": "337-560-9757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGRAVELLE",
        "first_name": "MARTIN",
        "middle_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "MD011998",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5052399",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1147303",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• DDMS of Louisiana No 2, LLC
• DDMS of Louisiana No 2, LLC
• Jawaskie Deal, LPC
• Ellen H Deaton, L.C.S.W.
• Kimberly Degeyter, SLP
• Delannie Nichole Delahoussaye
• Jada Renee Delahoussaye
• Kristi Sirran Delahoussaye, LCSW
• Nicole Ashley Delahoussaye, LCSW
• Damian Joseph Delhomme, MD

• Pediatrics Physician in New Iberia, LA
• Providers in New Iberia, LA by specialty
• Pediatrics Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.