Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PD007R | LA |
NPI | 1083674618 |
---|---|
Provider Name | Dr. Gregory Paul Lanata |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Bogalusa, LA 70427-3729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2006 |
Last Update Date | 29/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C0069 | BLUECROSS PIN (01) | LA |
T19712 | (02) | LA |