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Individual

DR. TERRY LAIRMORE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
321853
LA
208600000X
Surgery Physician
M1193
TX
2086X0206X
Surgical Oncology Physician
Primary
321853
LA
2086X0206X
Surgical Oncology Physician
M1193
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1728842-01
TX
01
1728842-02
CSHCN
TX
01
8S0392
BLUE SHIELD
TX
Enumeration date
03/24/2006
Last updated
06/23/2023
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