Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | LA |
NPI | 1558401695 |
---|---|
Provider Name | Dr. Grady Michael Stimits |
First Address | Shreveport, LA 71101-4611 |
Second Address | Shreveport, LA 71101-4611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |