Provider Demographics
NPI:1073564829
Name:LACY, GREGORY LAMONT II (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LAMONT
Last Name:LACY
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:1990 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70363-7055
Mailing Address - Country:US
Mailing Address - Phone:985-868-9300
Mailing Address - Fax:985-851-0053
Practice Address - Street 1:800 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1369
Practice Address - Country:US
Practice Address - Phone:203-785-2815
Practice Address - Fax:203-785-4043
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA15489R208800000X
CT71573208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2336495Medicaid
LA296749YH4EMedicare PIN