Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 5548 | LA |
Y | 213EG0000X | General Practice | 5548 | LA |
NPI | 1003919374 |
---|---|
Provider Name | Dr. Edwin L Bercier IV |
First Address | Rayne, LA 70578-0804 |
Second Address | Rayne, LA 70578-6551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1855481 | (05) | LA |