Doctor Name: | LACEY MILLET CAVANAUGH |
NPI Number: | 1437390416 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | MD203896 |
Business Practice Address: | 1611 Hampton St Vinton, LA - 706683707 |
Business Phone Number: | 3375895951 |
Business Fax Number: | 3375894013 |
Mailing Address: | 1611 Hampton St, VINTON |
State: | LA |
Postal Code: | 706683707 |
Phone Number: | 3375895951 |
Fax Number: | 3375894013 |
NPI Enumeration Date: | 03/20/2009 |
NPI Last Update Date: | 05/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | MD203896 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | LA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |