Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 1363 | LA |
NPI | 1396871232 |
---|---|
Provider Name | Dr. Gary V Mertz |
First Address | Lake Charles, LA 70601-7976 |
Second Address | Lake Charles, LA 70601-7976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 08/07/2007 |