Healthcare Provider Details

I. General information

NPI: 1619005238
Provider Name (Legal Business Name): MR. LEE CARRICUT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 E PINHOOK RD
LAFAYETTE LA
70501-8534
US

IV. Provider business mailing address

224 E PINHOOK RD
LAFAYETTE LA
70501-8534
US

V. Phone/Fax

Practice location:
  • Phone: 337-267-3003
  • Fax: 337-289-6600
Mailing address:
  • Phone: 337-267-3003
  • Fax: 337-289-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: