Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 306012 | LA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 306012 | LA |
NPI | 1114217858 |
---|---|
Provider Name | Dr. Gleb Medvedev |
First Address | New Orleans, LA 70112-2632 |
Second Address | New Orleans, LA 70112-2632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 10/07/2017 |