Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 021119 | LA |
NPI | 1033161567 |
---|---|
Provider Name | Dr. Allen Roy Pearce |
First Address | Baton Rouge, LA 70808 |
Second Address | Baton Rouge, LA 70808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 27/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1650358 | (05) | LA |
180037640 | RAILROAD MEDICARE (01) | LA |
F87338 | (02) | LA |