Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | M1695 | TX |
Y | 207RP1001X | Pulmonary Disease | MD.13300R | LA |
N | 207RP1001X | Pulmonary Disease | MD062425L | PA |
NPI | 1043255177 |
---|---|
Provider Name | Dr. Charles Ujay Gbadouwey |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Monroe, LA 71201-7407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 07/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
101387928 | (05) | PA |