Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | MD.203465 | LA |
NPI | 1154581882 |
---|---|
Provider Name | Dr. Lawrence Mariano Simon |
First Address | Eunice, LA 70535-5125 |
Second Address | Eunice, LA 70535-5125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2008 |
Last Update Date | 19/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1154581882 | (05) | CA |