Healthcare Provider Details

I. General information

NPI: 1760595011
Provider Name (Legal Business Name): LOUISE LAMARRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 BOLTON BOONE DR SUITE B
DESOTO TX
75115-2074
US

IV. Provider business mailing address

2617 BOLTON BOONE DR SUITE B
DESOTO TX
75115-2074
US

V. Phone/Fax

Practice location:
  • Phone: 972-709-1781
  • Fax: 972-709-1782
Mailing address:
  • Phone: 972-709-1781
  • Fax: 972-709-1782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG6995
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG6955
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberG6955
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG6955
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG6955
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: