Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 1913 | LA |
NPI | 1114081890 |
---|---|
Provider Name | Dr. Leon Fournet |
First Address | Metairie, LA 70006-2933 |
Second Address | Metairie, LA 70006-2933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A2041 | BLUE CROSS BLUE SHIELD (01) | LA |
T19739 | (02) | LA |