Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 11067R | LA |
N | 208D00000X | General Practice Physician | 11067R | LA |
NPI | 1003831942 |
---|---|
Provider Name | Dr. Melville Q. Wyche III |
First Address | New Orleans, LA 70122-1202 |
Second Address | New Orleans, LA 70122-1202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 11/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1652717 | (05) | LA |
F64316 | (02) | LA |