Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 04712R | LA |
NPI | 1053352328 |
---|---|
Provider Name | Dr. Antti G Maran |
First Address | Monroe, LA 71201 |
Second Address | Monroe, LA 71201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 06/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1301469 | (05) | LA |
B61762 | (02) |