Provider Demographics
NPI:1346565249
Name:LAWSON, SIMONE LORRAINE (MD)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:LORRAINE
Last Name:LAWSON
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 1:1101 MEDICAL CTR. BLVD.
Mailing Address - Street 2:PEDIATRIC ER
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-1554
Mailing Address - Fax:504-349-1146
Practice Address - Street 1:1101 MEDICAL CTR. BLVD.
Practice Address - Street 2:PEDIATRIC ER
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-1554
Practice Address - Fax:504-349-1146
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA204729208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2106988Medicaid