Basic Information
| Provider Information | |||||||||
| NPI: | 1063493963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAWSON | ||||||||
| FirstName: | ESTHER | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1666 E BERT KOUN LOOP STE 105 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182123520 | ||||||||
| FaxNumber: | 3182123525 | ||||||||
| Practice Location | |||||||||
| Address1: | 1666 E BERT KOUN LOOP STE 105 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182123520 | ||||||||
| FaxNumber: | 3182123525 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 04/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 199935 | LA | N | Other Service Providers | Specialist | 207Q00000X | R0871 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1059072 | 05 | LA | MEDICAID |