Provider Demographics
NPI:1295751006
Name:LAIN, TERRY J (MD)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:J
Last Name:LAIN
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 1:5610 READ BLVD.
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-3413
Mailing Address - Country:US
Mailing Address - Phone:504-241-8188
Mailing Address - Fax:504-264-5941
Practice Address - Street 1:5610 READ BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-3106
Practice Address - Country:US
Practice Address - Phone:504-241-8188
Practice Address - Fax:504-264-5941
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.2017932084B0040X
LAMD-2017932084B0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1094544Medicaid
AR154925001Medicaid
AR154925001Medicaid
LA1094544Medicaid
ARRL4103949OtherDEA #