Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 204834 | LA |
N | 2080P0205X | Pediatric Endocrinologist | 204834 | LA |
NPI | 1275782120 |
---|---|
Provider Name | Dr. Neslihan Gungor |
First Address | Shreveport, LA 71103-3822 |
Second Address | Shreveport, LA 71103-4228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2008 |
Last Update Date | 11/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2162896 | (05) | LA |
4Q543F600 | MEDICARE PTAN (01) | LA |