Provider Demographics
NPI:1851307748
Name:MCLAIN, ELIZABETH WOOD (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WOOD
Last Name:MCLAIN
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:PO BOX 919229
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-9229
Mailing Address - Country:US
Mailing Address - Phone:337-289-8944
Mailing Address - Fax:
Practice Address - Street 1:1211 COOLIDGE BLVD STE 404
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2638
Practice Address - Country:US
Practice Address - Phone:337-289-8478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024327207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1186228Medicaid
LAP00464877OtherRAILROAD MEDICARE
LAP00464877OtherRAILROAD MEDICARE
H37754Medicare UPIN
LA1441872Medicaid