Healthcare Provider Details

I. General information

NPI: 1851787071
Provider Name (Legal Business Name): JOHN P LAVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2449 HOSPITAL DR STE 280
BOSSIER CITY LA
71111-1900
US

IV. Provider business mailing address

2449 HOSPITAL DR STE 280
BOSSIER CITY LA
71111-1900
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-7288
  • Fax: 318-212-7295
Mailing address:
  • Phone: 318-212-7288
  • Fax: 318-212-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number306928
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: