Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 24302 | LA |
NPI | 1003819350 |
---|---|
Provider Name | Dr. James Desporte Lilly |
First Address | New Orleans, LA 70072-3151 |
Second Address | New Orleans, LA 70115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 23/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1543560 | (05) | LA |
I06473 | (02) | LA |