Provider Demographics
NPI:1447555420
Name:LEMOINE, JOHN EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:LEMOINE
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 1:597 TUNICA DR W
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2628
Mailing Address - Country:US
Mailing Address - Phone:318-253-0677
Mailing Address - Fax:318-253-0679
Practice Address - Street 1:597 TUNICA DR W
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2628
Practice Address - Country:US
Practice Address - Phone:318-253-0677
Practice Address - Fax:318-253-0679
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD010381207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1106411Medicaid
LA1106411Medicaid