Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 09-1139 | AZ |
NPI | 1083940860 |
---|---|
Provider Name | Dr. Jean-Luc Le Provost II |
First Address | Phoenix, AZ 85008-5308 |
Second Address | Phoenix, AZ 85008-5308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2009 |
Last Update Date | 28/10/2009 |