Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 761 | LA |
NPI | 1285612150 |
---|---|
Provider Name | Dr. Meril Joseph Dufrene, Jr. |
First Address | Alexandria, LA 71301-3372 |
Second Address | Alexandria, LA 71301-3372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2006 |
Last Update Date | 30/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3079A | BLUE CROSS/BLUE SHIELD (01) | LA |
T20015 | (02) | LA |