Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | J2144 | TX |
NPI | 1114924396 |
---|---|
Provider Name | Alfred L. Laborde |
First Address | San Antonio, TX 78233-6213 |
Second Address | San Antonio, TX 78229-3342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2005 |
Last Update Date | 04/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102129701 | (05) | TX |
C38190 | (02) | TX |