Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 204411 | LA |
N | 207X00000X | Orthopaedic Surgeon | ME 101035 | FL |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 204411 | LA |
NPI | 1063673424 |
---|---|
Provider Name | Dr. Carlton Gregory Houtz |
First Address | Shreveport, LA 71105-5634 |
Second Address | Shreveport, LA 71105-5634 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2008 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2163795 | (05) | LA |