Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 5880 | LA |
NPI | 1184885907 |
---|---|
Provider Name | Dr. Jimmy Anthony Babineaux JR. |
First Address | Lafayette, LA 70503-3159 |
Second Address | Lafayette, LA 70503-3159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2008 |
Last Update Date | 22/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1893145 | (05) | LA |