Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | M1193 | TX |
N | 208600000X | Surgeon | M1193 | TX |
Y | 2086X0206X | Surgical Oncologist | 321853 | LA |
N | 2086X0206X | Surgical Oncologist | M1193 | TX |
NPI | 1083674949 |
---|---|
Provider Name | Dr. Terry Lairmore |
First Address | Shreveport, LA 71103-3822 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 28/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1728842-01 | (05) | TX |
1728842-02 | CSHCN (01) | TX |
8S0392 | BLUE SHIELD (01) | TX |
G04787 | (02) | TX |