Provider Demographics
NPI:1760595011
Name:LAMARRE, LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:
Last Name:LAMARRE
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 1:2617 BOLTON BOONE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2074
Mailing Address - Country:US
Mailing Address - Phone:972-709-1781
Mailing Address - Fax:972-709-1782
Practice Address - Street 1:2617 BOLTON BOONE DR
Practice Address - Street 2:SUITE B
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2074
Practice Address - Country:US
Practice Address - Phone:972-709-1781
Practice Address - Fax:972-709-1782
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6995207Q00000X
TXG6955207QA0505X, 207QS0010X, 208D00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139969323Medicaid
TX8943B6Medicare ID - Type Unspecified
C18105Medicare UPIN