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General NPI Number Information
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NPI Number | 1811027881
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Entity Type | Organization
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Legal Business Name | LAWRENCE I. RUSSELL, M.D.,LTD
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 601 W SAINT MARY BLVD STE. 200
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City | LAFAYETTE
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State | LA
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Zip | 70506-3568
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Country | US
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Telephone | 337-233-7300
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Fax | 337-233-5685
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Provider Business Mailing Address
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Address Line | 601 W SAINT MARY BLVD STE. 200
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City | LAFAYETTE
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State | LA
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Zip | 70506-3568
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Country | US
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Telephone | 337-233-7300
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Fax | 337-233-5685
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LAWRENCE IRWIN RUSSELL
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Credential | M.D.
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Telephone | 337-233-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 014024
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License Number State | LA
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