Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | 024902 | LA |
NPI | 1477699387 |
---|---|
Provider Name | Charles T Clasen III |
First Address | Metairie, LA 70006 |
Second Address | Metairie, LA 70006-3000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1420425 | (05) | LA |