Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | P65627 | NY |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 302017 | LA |
NPI | 1518122845 |
---|---|
Provider Name | Dr. Andrew Meram |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103-4228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2008 |
Last Update Date | 28/03/2018 |