Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 014726 | LA |
NPI | 1003895756 |
---|---|
Provider Name | Dr. Michael Eddie Cormier |
First Address | Lake Charles, LA 70605-4171 |
Second Address | Lake Charles, LA 70605-4171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2006 |
Last Update Date | 15/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1360660 | (05) | LA |
B63368 | (02) | LA |