Provider Demographics
NPI:1619005238
Name:CARRICUT, LEE
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:CARRICUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 E PINHOOK RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-8534
Mailing Address - Country:US
Mailing Address - Phone:337-267-3003
Mailing Address - Fax:337-289-6600
Practice Address - Street 1:224 E PINHOOK RD
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-8534
Practice Address - Country:US
Practice Address - Phone:337-267-3003
Practice Address - Fax:337-289-6600
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications