Provider Demographics
NPI:1194794800
Name:LIRETTE, AARON L (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:L
Last Name:LIRETTE
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 1:2300 HOSPITAL DR.
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111
Mailing Address - Country:US
Mailing Address - Phone:318-212-7523
Mailing Address - Fax:318-212-7757
Practice Address - Street 1:2300 HOSPITAL DR.
Practice Address - Street 2:SUITE 180
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-212-7523
Practice Address - Fax:318-212-7757
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1484890Medicaid
LA080174839OtherRR MEDICARE
LA5E610Medicare PIN
LA5E610Medicare ID - Type UnspecifiedMEDICARE
LA1484890Medicaid