Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 322365 | LA |
N | 208000000X | Pediatrician | 322365 | LA |
NPI | 1629480173 |
---|---|
Provider Name | David Rayburn |
First Address | New Orleans, LA 70118-5798 |
Second Address | New Orleans, LA 70118-5798 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2014 |
Last Update Date | 19/08/2020 |