Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 11473 | MS |
Y | 2084N0400X | Neurologist | 11473 | LA |
N | 2084N0400X | Neurologist | 11473 | MS |
NPI | 1053494831 |
---|---|
Provider Name | Dr. David Glen Mchenry |
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 | 23/10/2006 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18132 | (05) | MS |
B29915 | (02) | MS |