Individual
EDMUND GERARD LACOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1118 ROSS CLARK CIR, SUITE 100, DOTHAN, AL 36301-3001
(334) 794-1148
(334) 793-1954
Mailing address
1118 ROSS CLARK CIR, SUITE 100, DOTHAN, AL 36301-3001
(334) 794-1148
(334) 793-1954
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
00016999
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017489
TRICARE
AL
01
—
051516047
BCBS
AL
05
—
51553686
—
AL
Enumeration date
05/24/2006
Last updated
01/24/2012
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