Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | J4285 | TX |
NPI | 1093809410 |
---|---|
Provider Name | Dr. John L. Lanoue |
First Address | Dallas, TX 75251-2116 |
Second Address | Dallas, TX 75251-2116 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 19/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1074006003 | CIGNA (01) | TX |
116113506 | (05) | TX |
8J5630 | BLUE CROSS/BLUE SHIELD (01) | TX |
G21514 | (02) | TX |