Individual
LACEY MILLET CAVANAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1905 COUNTRY CLUB RD, LAKE CHARLES, LA 70605-5203
(337) 990-8000
Mailing address
1905 COUNTRY CLUB RD, LAKE CHARLES, LA 70605-5203
(337) 990-8000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.203896
LA
208D00000X
General Practice Physician
MD203896
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/20/2009
Last updated
07/11/2016
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