Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD011582 | LA |
NPI | 1023061264 |
---|---|
Provider Name | Bennie Peter Nobles JR. |
First Address | Metairie, LA 70006-3021 |
Second Address | Metairie, LA 70006-3021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1149543 | (05) | LA |
D04243 | (02) |