Basic Information
| Provider Information | |||||||||
| NPI: | 1063485811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TORRENCE | ||||||||
| FirstName: | LEAMON | ||||||||
| MiddleName: | GARRETT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 11TH ST NE | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710754503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391700 | ||||||||
| FaxNumber: | 3185395688 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 11TH ST NE | ||||||||
| Address2: | |||||||||
| City: | SPRINGHILL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 710754503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185391700 | ||||||||
| FaxNumber: | 3185395688 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 10/19/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 17882 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 95096 | 01 | AR BLUE CROSS | OTHER | 1349402 | 05 | LA | MEDICAID | 15711 | 01 | LA CDS | OTHER | AT3143144 | 01 | DEA | OTHER |