=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053324566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM ST JOHN LACORTE, PMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2006
-----------------------------------------------------
Last Update Date | 03/19/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 519 METAIRIE RD STE 100
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-838-6000
-----------------------------------------------------
Fax | 504-835-6685
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 55336
-----------------------------------------------------
City | METAIRIE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70055-5336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-838-6000
-----------------------------------------------------
Fax | 504-835-6685
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM S LACORTE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 504-838-6000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 012633
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------