Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD012268 | LA |
Y | 208600000X | Surgeon | MD012268 | LA |
N | 2086X0206X | Surgical Oncologist | MD012268 | LA |
NPI | 1407879323 |
---|---|
Provider Name | Dr. Joseph Benton Dupont JR. |
First Address | Baton Rouge, LA 70809-3731 |
Second Address | Baton Rouge, LA 70806-3743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 16/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1196177 | (05) | LA |
270476YUB6 | MEDICARE PTAN (01) | LA |
5DG10 | MEDICARE GROUP PTAN (01) | LA |
B83915 | (02) |