Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 14015R | LA |
NPI | 1114978855 |
---|---|
Provider Name | Deeb Sudd |
First Address | Lafayette, LA 70508-3870 |
Second Address | New Iberia, LA 70560-4031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 25/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1439967 | (05) | LA |
G74845 | (02) | LA |