Provider Demographics
NPI:1184678229
Name:LACOUR, ALLEN J (MD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:J
Last Name:LACOUR
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:PO BOX 1608
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70063-1608
Mailing Address - Country:US
Mailing Address - Phone:225-922-7961
Mailing Address - Fax:225-930-7524
Practice Address - Street 1:1202 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2330
Practice Address - Country:US
Practice Address - Phone:985-898-4000
Practice Address - Fax:225-930-7524
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0166422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1350508Medicaid
LA53509Medicare ID - Type UnspecifiedLA MEDICARE PROVIDER #
LA1350508Medicaid