Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 019600 | LA |
NPI | 1033271317 |
---|---|
Provider Name | Donald R Peavy |
First Address | Baton Rouge, LA 70896-6455 |
Second Address | Baton Rouge, LA 70806-4019 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 06/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1918199 | (05) | LA |
E56730 | (02) |