Provider Demographics
NPI:1801397005
Name:TIGAS, LOURENTE BACUS (MD)
Entity Type:Individual
Prefix:
First Name:LOURENTE
Middle Name:BACUS
Last Name:TIGAS
Suffix:
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 1:330 QUAIL CT
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KY
Mailing Address - Zip Code:41169-1575
Mailing Address - Country:US
Mailing Address - Phone:606-836-8303
Mailing Address - Fax:
Practice Address - Street 1:330 QUAIL CT
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KY
Practice Address - Zip Code:41169-1575
Practice Address - Country:US
Practice Address - Phone:606-836-8303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20101207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology