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General NPI Number Information
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NPI Number | 1043451008
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Entity Type | Individual
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Provider Name | MELISSA LALANDE RASBERRY M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 1920 W SALE RD BLDG F, SUITE 2
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City | LAKE CHARLES
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State | LA
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Zip | 70605-2400
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Country | US
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Telephone | 337-474-2856
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Fax | 337-480-0645
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Provider Business Mailing Address
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Address Line | 501 DR MICHAEL DEBAKEY DR
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City | LAKE CHARLES
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State | LA
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Zip | 70601-5724
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Country | US
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Telephone | 337-312-8258
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Fax | 337-312-6711
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 203911
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License Number State | LA
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