Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 7049 | LA |
NPI | 1104455401 |
---|---|
Provider Name | Dr. Grace Elizabeth Beck Coburn |
First Address | Metairie, LA 70001-2196 |
Second Address | Metairie, LA 70001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2020 |
Last Update Date | 05/11/2020 |