Provider Demographics
NPI:1750431755
Name:LAVEDAN, PIERRE J (MD)
Entity type:Individual
Prefix:
First Name:PIERRE
Middle Name:J
Last Name:LAVEDAN
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 1:601 CLARA BARTON BLVD STE 340
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-5755
Mailing Address - Country:US
Mailing Address - Phone:469-800-2260
Mailing Address - Fax:972-487-5251
Practice Address - Street 1:601 CLARA BARTON BLVD STE 340
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5755
Practice Address - Country:US
Practice Address - Phone:469-800-2260
Practice Address - Fax:972-487-5251
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19703207Q00000X, 207QH0002X
TXJ6540207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3475493-01Medicaid
TX413546YKY6Medicare Oscar/Certification