Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO.000309 | LA |
N | 207P00000X | Emergency Physician | DO.000309 | LA |
Y | 207Q00000X | Family Doctor | DO.000309 | LA |
N | 207QS0010X | Family Doctor - Sports Medicine | DO.000309 | LA |
NPI | 1073742425 |
---|---|
Provider Name | Dr. Creighton E Shute |
First Address | Lafayette, LA 70503-5334 |
Second Address | Lafayette, LA 70503-5334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 09/09/2019 |