Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD021832 | LA |
NPI | 1023151198 |
---|---|
Provider Name | Dr. James Gordon Gengelbach |
First Address | Baton Rouge, LA 70809-3076 |
Second Address | Baton Rouge, LA 70809-3076 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A66607 | (02) |