Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 025268 | LA |
Y | 111NI0900X | Internist | 025268 | LA |
N | 207RH0002X | Hospice and Palliative Medicine | 025268 | LA |
NPI | 1144221060 |
---|---|
Provider Name | Dr. Andre Alber Bonnecaze |
First Address | Baton Rouge, LA 70808-4375 |
Second Address | Baton Rouge, LA 70808-4375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 04/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03120809 | (05) | MS |
1574864 | (05) | LA |
H78345 | (02) | LA |
P00043115 | RAIL ROAD MEDICARE (01) |