Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 018524 | LA |
N | 207QA0401X | Family Doctor - Addiction Medicine | 018524 | LA |
NPI | 1346205507 |
---|---|
Provider Name | Clifton Wales Salmon JR. |
First Address | Homer, LA 71040-0300 |
Second Address | Homer, LA 71040-2100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 15/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1358827 | (05) | LA |
B65328 | (02) | LA |