Healthcare Provider Details

I. General information

NPI: 1568682474
Provider Name (Legal Business Name): JEFFREY LACOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR SUITE 301
HAMMOND LA
70403-1495
US

IV. Provider business mailing address

PO BOX 2668
HAMMOND LA
70404-2668
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-2630
  • Fax: 985-230-2634
Mailing address:
  • Phone: 985-230-2630
  • Fax: 985-230-2634

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 Code207Y00000X
TaxonomyOtolaryngology Physician
License Number026458
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: