Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 202843 | LA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 202843 | LA |
NPI | 1801869409 |
---|---|
Provider Name | Christian J Wold |
First Address | Alexandria, LA 71303-3538 |
Second Address | Alexandria, LA 71303-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2006 |
Last Update Date | 12/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1887137 | (05) | LA |
568983000 | (05) | MN |
I41885 | (02) | |
P00448380 | MEDICARE, RAILROAD (01) | MN |