Basic Information
Provider Information
NPI: 1770775314
EntityType: 2
ReplacementNPI:  
OrganizationName: LAWRENCE P MENACHE MD APMC
LastName:  
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Mailing Information
Address1: PO BOX 13285
Address2:  
City: ALEXANDRIA
State: LA
PostalCode: 713153285
CountryCode: US
TelephoneNumber: 3184849749
FaxNumber: 3184842505
Practice Location
Address1: 3330 MASONIC DR
Address2:  
City: ALEXANDRIA
State: LA
PostalCode: 713013841
CountryCode: US
TelephoneNumber: 3184486917
FaxNumber: 3184842505
Other Information
ProviderEnumerationDate: 08/17/2007
LastUpdateDate: 08/17/2007
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MENACHE
AuthorizedOfficialFirstName: LAWRENCE
AuthorizedOfficialMiddleName: P
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 3184849749
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0001XMD08338RLAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology

ID Information
IDTypeStateIssuerDescription
190185705LA MEDICAID


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