Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | DO.025843 | LA |
N | 207PP0204X | Pediatric Emergency Physician | MD.025843 | LA |
Y | 208000000X | Pediatrician | DO.025843 | LA |
NPI | 1235163627 |
---|---|
Provider Name | Dr. Brent K Combs |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Baton Rouge, LA 70809-3489 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 28/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09421371 | (05) | MS |
1046361 | (05) | LA |