Healthcare Provider Details

I. General information

NPI: 1043451008
Provider Name (Legal Business Name): MELISSA LALANDE RASBERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 W SALE RD BLDG F, SUITE 2
LAKE CHARLES LA
70605-2400
US

IV. Provider business mailing address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

V. Phone/Fax

Practice location:
  • Phone: 337-474-2856
  • Fax: 337-480-0645
Mailing address:
  • Phone: 337-312-8258
  • Fax: 337-312-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number203911
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: