Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD.11395R | LA |
NPI | 1063458438 |
---|---|
Provider Name | Dr. Chris Theodossiou |
First Address | New Orleans, LA 70121-2429 |
Second Address | Covington, LA 70433-8107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1675679 | (05) | LA |
F74138 | (02) |