Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 019709 | LA |
N | 208200000X | Surgeon | 019709 | LA |
N | 208600000X | Surgeon | 019709 | LA |
NPI | 1477573301 |
---|---|
Provider Name | Donnie Franklin Aultman |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1968552 | (05) | LA |
F59258 | (02) | LA |