Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 011336 | LA |
NPI | 1013986090 |
---|---|
Provider Name | Carl B Alldredge |
First Address | Lafayette, LA 70505-2068 |
Second Address | Lafayette, LA 70503-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 10/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1170224 | (05) | LA |
E04980 | (02) |