MEDICARE: JOHN P LAVO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Y00000X	Otolaryngology Physician	306928	LA

General Provider Information

NPI Number	:	1851787071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P LAVO MD

Provider Business Mailing Address
First Line	:	2449 HOSPITAL DR STE 440
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-1918
Country	:	US
Telephone Number	:	318-212-7288
Fax Number	:	318-212-7295

Provider Business Practice Location Address
First Line	:	2449 HOSPITAL DR STE 440
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-1918
Country	:	US
Telephone Number	:	318-212-7288
Fax Number	:	318-212-7295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	06/30/2021

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Directions to “ JOHN P LAVO MD” Practice Location

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