Provider Demographics
NPI:1073586129
Name:LASQUETY, LUDOVIC M (MD)
Entity Type:Individual
Prefix:
First Name:LUDOVIC
Middle Name:M
Last Name:LASQUETY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5147 N 9TH AVE
Mailing Address - Street 2:STE. 203
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8771
Mailing Address - Country:US
Mailing Address - Phone:850-476-6110
Mailing Address - Fax:850-479-6042
Practice Address - Street 1:5147 N 9TH AVE
Practice Address - Street 2:STE. 203
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8771
Practice Address - Country:US
Practice Address - Phone:850-476-6110
Practice Address - Fax:850-479-6042
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933731OtherAL MEDICAID
FL262663200OtherMEDICAID
FL58811OtherBLUE CROSS BLUE SHIELD
AL59068247LASOtherBCBS AL
AL009933731OtherAL MEDICAID
FL58811AMedicare PIN