Provider Demographics
NPI:1275515165
Name:LACOSTE, ALAN DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:DANIEL
Last Name:LACOSTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:DANIEL
Other - Last Name:LACOSTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1767 IMPERIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5362
Mailing Address - Country:US
Mailing Address - Phone:337-478-3810
Mailing Address - Fax:337-478-6360
Practice Address - Street 1:1767 IMPERIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5362
Practice Address - Country:US
Practice Address - Phone:337-478-3810
Practice Address - Fax:337-478-6360
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13078207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187887Medicaid
LA180011357OtherRAILROAD MEDICARE
LA720680677011OtherCIGNA
LA720680677011OtherCIGNA