Healthcare Provider Details

I. General information

NPI: 1164518205
Provider Name (Legal Business Name): LAVIAS M. BURNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/14/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR STE 200
HAMMOND LA
70403-1431
US

IV. Provider business mailing address

7421 JADE ST
NEW ORLEANS LA
70124-3538
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-7650
  • Fax:
Mailing address:
  • Phone: 618-581-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036109909
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number325150
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: