Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 1916 | LA |
NPI | 1003943788 |
---|---|
Provider Name | Dr. Marshall Ivan Gottsegen |
First Address | New Orleans, LA 70130-7100 |
Second Address | New Orleans, LA 70115-2427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |