Healthcare Provider Details

I. General information

NPI: 1932125358
Provider Name (Legal Business Name): LOURDES PATHOLOGISTS APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 SAINT LANDRY ST
LAFAYETTE LA
70506-4627
US

IV. Provider business mailing address

PO BOX 52545
LAFAYETTE LA
70505-2545
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-3659
  • Fax: 337-232-6962
Mailing address:
  • Phone: 337-234-3659
  • Fax: 337-232-6962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SIDNEY B GRAY
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 227-234-3659