Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | MD4222R | LA |
NPI | 1104993708 |
---|---|
Provider Name | Dr. Myron Ernest Moorehead II |
First Address | Kenner, LA 70065-2474 |
Second Address | Kenner, LA 70065-2474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 20/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
092522606 | CONTROLLED SUBSTANCE LIC (01) | LA |
B60947 | (02) | |
B60947 | (02) | LA |