Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | F1107 | TX |
NPI | 1356495576 |
---|---|
Provider Name | Dr. Claude Larose |
First Address | Kingwood, TX 77339 |
Second Address | Kingwood, TX 77339 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 04/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0031KN | BCBS GROUP (01) | TX |
8K1167 | BCBS INDIVIDUAL (01) | |
C18170 | (02) | TX |