Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD.200825 | LA |
NPI | 1720006687 |
---|---|
Provider Name | Dr. Paul E Fenn JR. |
First Address | Lafayette, LA 70508-8520 |
Second Address | Lafayette, LA 70508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 07/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I37944 | (02) | MA |