Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01025396A | IN |
NPI | 1003816711 |
---|---|
Provider Name | David P Lloyd |
First Address | Fort Wayne, IN 46845-1701 |
Second Address | Fort Wayne, IN 46845-1730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000595621 | ANTHEM (01) | IN |
0471636 | (05) | OH |
100361030 | (05) | IN |
100361030B | (05) | IN |
B28135 | (02) | |
P00755201 | MEDICARE RR (01) | IN |