Provider Demographics
NPI:1609821883
Name:MCLEMORE, HENRY E II (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:E
Last Name:MCLEMORE
Suffix:II
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 53076
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3076
Mailing Address - Country:US
Mailing Address - Phone:337-289-2180
Mailing Address - Fax:337-289-2677
Practice Address - Street 1:611 SAINT LANDRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-4627
Practice Address - Country:US
Practice Address - Phone:337-289-2180
Practice Address - Fax:337-289-2677
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0111322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1165611Medicaid
LAB61231Medicare UPIN
LA1165611Medicaid
LA5L193DG58Medicare PIN
LA300137195Medicare PIN