Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VG0400X | Gynecologist | MD.207001 | LA |
Y | 207VX0000X | Obstetrician | MD.207001 | LA |
NPI | 1306251582 |
---|---|
Provider Name | Dr. Jimmy William Skrasek |
First Address | Lafayette, LA 70503-2621 |
Second Address | Lafayette, LA 70503-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 17/03/2018 |