Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 018940 | LA |
NPI | 1083772883 |
---|---|
Provider Name | Dr. Bryant Gerard George SR. |
First Address | New Orleans, LA 70162-2600 |
Second Address | Lake Charles, LA 70601-5815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 05/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1378356 | (05) | LA |
D66126 | (02) |