Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 304275 | LA |
NPI | 1053545152 |
---|---|
Provider Name | Dr. Marlon Andre Medford |
First Address | Alexandria, LA 71301-8421 |
Second Address | Alexandria, LA 71301-8421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 17/03/2018 |