Provider Demographics
NPI:1811027881
Name:LAWRENCE I. RUSSELL, M.D.,LTD
Entity Type:Organization
Organization Name:LAWRENCE I. RUSSELL, M.D.,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-233-7300
Mailing Address - Street 1:601 W SAINT MARY BLVD
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3568
Mailing Address - Country:US
Mailing Address - Phone:337-233-7300
Mailing Address - Fax:337-233-5685
Practice Address - Street 1:601 W SAINT MARY BLVD
Practice Address - Street 2:STE. 200
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3568
Practice Address - Country:US
Practice Address - Phone:337-233-7300
Practice Address - Fax:337-233-5685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014024207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1167169Medicaid
LA1167169Medicaid
LA5K800Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER