Provider Demographics
NPI:1043260326
Name:LACOUR, FRITZ A (MD)
Entity type:Individual
Prefix:DR
First Name:FRITZ
Middle Name:A
Last Name:LACOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16700 MUIRFIELD CT
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-2562
Mailing Address - Country:US
Mailing Address - Phone:251-960-1398
Mailing Address - Fax:
Practice Address - Street 1:16700 MUIRFIELD CT
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551-2562
Practice Address - Country:US
Practice Address - Phone:251-960-1398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL78212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL43508Medicaid
AL43508Medicaid
43508Medicare ID - Type UnspecifiedPROVIDER NUMBER
AL051538386Medicare PIN