Healthcare Provider Details

I. General information

NPI: 1760836597
Provider Name (Legal Business Name): CORY LEMOINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2016
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 SAINT NAZAIRE RD
BROUSSARD LA
70518-4257
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-7450
  • Fax: 337-839-0110
Mailing address:
  • Phone: 337-470-7580
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number309437
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: