Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 14474R | LA |
NPI | 1164413381 |
---|---|
Provider Name | Dr. Christopher E Lagraize |
First Address | Lafayette, LA 70505-2803 |
Second Address | Lafayette, LA 70508-5738 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 18/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1445819 | (05) | LA |
H62476 | (02) |