Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 14873 | LA |
NPI | 1013917350 |
---|---|
Provider Name | Dr. Heber E Dunaway JR. |
First Address | Mandeville, LA 70448-4664 |
Second Address | Mandeville, LA 70448-4664 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C67257 | (02) | LA |