Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 19726 | LA |
NPI | 1053491233 |
---|---|
Provider Name | Dr. Pierre Dejace |
First Address | New Orleans, LA 70124-4404 |
Second Address | New Orleans, LA 70112-1262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1376906 | (05) | LA |
B65305 | (02) | LA |