Provider Demographics
NPI:1760836597
Name:LEMOINE, CORY (DO)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:LEMOINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:337-470-7580
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:109 SAINT NAZAIRE RD
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4257
Practice Address - Country:US
Practice Address - Phone:337-470-7450
Practice Address - Fax:337-839-0110
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA309437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program