Provider Demographics
NPI:1972594331
Name:LAGRAIZE, TAMI T (MD)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:T
Last Name:LAGRAIZE
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 52803
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-2803
Mailing Address - Country:US
Mailing Address - Phone:337-289-9701
Mailing Address - Fax:337-289-9702
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:SUITE 410
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-289-9701
Practice Address - Fax:337-289-9702
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14475R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1445819Medicaid
H61680Medicare UPIN
LA1445819Medicaid