Individual
DR. MARY LOIS LAVILLE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4630 AMBASSADOR CAFFERY PKWY, SUITE 412, LAFAYETTE, LA 70508-6949
(337) 993-3933
(337) 993-2689
Mailing address
4630 AMBASSADOR CAFFERY PKWY, SUITE 412, LAFAYETTE, LA 70508-6949
(337) 993-3933
(337) 993-2689
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
018789
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1399345
—
LA
01
—
4375751
AETNA
LA
01
—
DC2141
RAILROAD MEDICARE
LA
Enumeration date
11/19/2005
Last updated
07/08/2007
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