Provider Demographics
NPI:1649233974
Name:CHRISTY, LAWRENCE WAYNE I (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WAYNE
Last Name:CHRISTY
Suffix:I
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 1:600 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-6020
Mailing Address - Country:US
Mailing Address - Phone:337-232-8814
Mailing Address - Fax:337-234-8542
Practice Address - Street 1:600 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-6020
Practice Address - Country:US
Practice Address - Phone:337-232-8814
Practice Address - Fax:337-234-8542
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.014624208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1312959Medicaid
LA1312959Medicaid
LAB64744Medicare UPIN