Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 013609 | LA |
NPI | 1023350436 |
---|---|
Provider Name | Dr. Lloyd Henderson Frye |
First Address | Zachary, LA 70791-8531 |
Second Address | Zachary, LA 70791-8531 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2013 |
Last Update Date | 24/03/2013 |