Provider Demographics
NPI:1942232988
Name:LACOURT, CATHERINE L (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:L
Last Name:LACOURT
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 1:3420 E SHEA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3348
Mailing Address - Country:US
Mailing Address - Phone:480-977-6000
Mailing Address - Fax:248-269-0631
Practice Address - Street 1:3420 E SHEA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028
Practice Address - Country:US
Practice Address - Phone:480-977-6000
Practice Address - Fax:248-269-0631
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ957970Medicaid
AZG35894Medicare UPIN