Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 021413 | LA |
NPI | 1063511590 |
---|---|
Provider Name | Dr. Chi Phuong Dola |
First Address | Harvey, LA 70058-2302 |
Second Address | Harvey, LA 70058-2302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 09/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1699071 | (05) | LA |
G09560 | (02) |