| Organization Name: | LAFOURCHE MEDICAL GROUP |
| NPI Number: | 1730567256 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHEN LIM (MEDICAL DIRECTOR) |
| Mailing Address: | 4912 Highway 1 Raceland |
| State: | LA US |
| Postal Code: | 703942559 |
| Phone Number: | 9852423094 |
| Fax Number: | 9852423093 |
| NPI Enumeration Date: | 05/17/2015 |
| NPI Last Update Date: | 05/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |