Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD.014531 | LA |
N | 208000000X | Pediatrician | MD014531 | LA |
NPI | 1427018274 |
---|---|
Provider Name | Dr. Duane William Superneau |
First Address | Baton Rouge, LA 70806-7851 |
Second Address | Baton Rouge, LA 70806-7851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2006 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00119789 | (05) | MS |
1907421 | (05) | LA |
C76885 | (02) | LA |