Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 14097R | LA |
N | 2086S0129X | Vascular Surgeon | 22561 | MS |
NPI | 1154386712 |
---|---|
Provider Name | Dr. Michael Stanley Conners III |
First Address | Baton Rouge, LA 70809-2644 |
Second Address | Baton Rouge, LA 70808-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2006 |
Last Update Date | 22/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06925021 | (05) | MS |
1045063 | (05) | LA |
H85662 | (02) | LA |