Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 23250 | LA |
NPI | 1013023803 |
---|---|
Provider Name | Dr. Archie C Tatford |
First Address | Metairie, LA 70005-3256 |
Second Address | Slidell, LA 70458-2939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G97647 | (02) |