Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 05400R | LA |
NPI | 1174691034 |
---|---|
Provider Name | Dr. Linda Ann Doughty White |
First Address | New Orleans, LA 70187-0458 |
Second Address | New Orleans, LA 70126-3716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05400R | STATE MEDICAL LICENSE (01) | LA |
1319619 | (05) | LA |