Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD.06105R | LA |
N | 2080P0210X | Pediatric Nephrologist | MD.6105R | LA |
NPI | 1407191133 |
---|---|
Provider Name | Dr. Meena Ajit Bakare |
First Address | Mamou, LA 70554-3124 |
Second Address | Mamou, LA 70554-3124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2012 |
Last Update Date | 06/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1331384 | (05) | LA |