Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD.09232R | LA |
NPI | 1013082502 |
---|---|
Provider Name | Dr. Jean Alice Friday |
First Address | Sunrise, FL 33323-2865 |
Second Address | New Iberia, LA 70560-4031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1658782 | (05) | LA |
G42988 | (02) |