Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | LA2460 | LA |
NPI | 1184627788 |
---|---|
Provider Name | Dr. Michael J. Maginnis |
First Address | Baton Rouge, LA 70809-7601 |
Second Address | Baton Rouge, LA 70809-7601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1824607 | (05) | LA |
18931 | STATE DRUG LICENSE # (01) | LA |
AM5577070 | DEA REG # (01) | LA |
F7198 | BC/BS PROVIDER # (01) | LA |
LA2460 | DENTAL LICENSE # (01) | LA |
T19833 | (02) | LA |