Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 015807 | LA |
NPI | 1043260607 |
---|---|
Provider Name | Dr. James Mitchell Lipstate |
First Address | Lafayette, LA 70506-6778 |
Second Address | Lafayette, LA 70506-6778 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 24/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1358100 | (05) | LA |
1799475 | (05) | LA |
B-62964 | (02) | LA |