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NPI Code Detail

MEDICARE: CHARLES LAVIS M.D.

MEDICARE:   CHARLES  LAVIS  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianMD01919RLA

General Provider Information

NPI Number : 1225055015
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES LAVIS M.D.
Provider Business Mailing Address
First Line : PO BOX 2639
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78299-2639
Country : US
Telephone Number : 337-824-4403
Fax Number :
Provider Business Practice Location Address
First Line : 1125 MARGUERITE ST
Second Line :
City : MORGAN CITY
State : LA
Zip : 70380-1855
Country : US
Telephone Number : 985-384-2200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/16/2006
Last Update Date : 07/08/2007

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