Basic Information
| Provider Information | |||||||||
| NPI: | 1952832800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LACROIX | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | CARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1119 NW 41ST ST | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731185444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9188696208 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5246 BRITTANY DR | ||||||||
| Address2: | LSU EMERGENCY MEDICINE RESIDENCY PROGRAM | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708089136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257574142 | ||||||||
| FaxNumber: | 2257574230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 05/30/2019 | ||||||||
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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 | 207P00000X | 310881 | LA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.