Provider Demographics
NPI:1285619429
Name:LESSARD, LARRY (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:LESSARD
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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:TX
Mailing Address - Zip Code:77835-0185
Mailing Address - Country:US
Mailing Address - Phone:979-289-5509
Mailing Address - Fax:979-289-5509
Practice Address - Street 1:17207 KUYKENDAHL RD
Practice Address - Street 2:200
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-8423
Practice Address - Country:US
Practice Address - Phone:832-698-5320
Practice Address - Fax:832-698-5171
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF2807207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB24360Medicare UPIN