Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | 6480 | TX |
Y | 207Q00000X | Family Doctor | 309560 | LA |
NPI | 1972912467 |
---|---|
Provider Name | Dr. John Santogrossi |
First Address | Monroe, LA 71203-2624 |
Second Address | Monroe, LA 71202-6400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2014 |
Last Update Date | 06/09/2018 |