Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 3215 | LA |
NPI | 1013181312 |
---|---|
Provider Name | Dr. Paul Lawrence Wood |
First Address | Shreveport, LA 71106-2223 |
Second Address | Shreveport, LA 71106-2223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2008 |
Last Update Date | 17/04/2008 |