Healthcare Provider Details

I. General information

NPI: 1992790521
Provider Name (Legal Business Name): JOHN DAVID LAUZON M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E. PARRISH AVE BLDG B, STE 101
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

2200 E. PARRISH AVE BLDG B, STE 101
OWENSBORO KY
42303-1449
US

V. Phone/Fax

Practice location:
  • Phone: 270-683-3232
  • Fax: 270-852-1600
Mailing address:
  • Phone: 270-683-3232
  • Fax: 270-852-1600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31795
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: