Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD.205141 | LA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 80940 | MA |
N | 207XS0117X | Orthopaedic Spine Surgeon | 80940 | MA |
NPI | 1255319869 |
---|---|
Provider Name | Dr. John B Sledge III |
First Address | Lafayette, LA 70508-5783 |
Second Address | Lafayette, LA 70508-5783 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 10/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2183311 | (05) | LA |
3145832 | (05) | MA |
733396 | TUFTS (01) | MA |
J04636 | (02) | |
J31314 | BCBS (01) | MA |