Provider Demographics
NPI:1053459784
Name:LAGARDE, GINA PAYTON (MD)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:PAYTON
Last Name:LAGARDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15481 W CLUB DELUXE RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1466
Mailing Address - Country:US
Mailing Address - Phone:985-543-4880
Mailing Address - Fax:985-543-4888
Practice Address - Street 1:15481 W CLUB DELUXE RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1466
Practice Address - Country:US
Practice Address - Phone:985-543-4880
Practice Address - Fax:985-543-4888
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020356208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1934283Medicaid
LAF37056Medicare UPIN
LA1934283Medicaid