Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 014118 | LA |
NPI | 1134182082 |
---|---|
Provider Name | Dr. Laurence F Hiller |
First Address | Irving, TX 75038-3813 |
Second Address | Shreveport, LA 71105-6800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 13/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1350834 | (05) | LA |
B62129 | (02) | LA |