Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 14951R | LA |
NPI | 1023009263 |
---|---|
Provider Name | Dr. Robert Chance Dewitt |
First Address | Alexandria, LA 71301-3900 |
Second Address | Alexandria, LA 71301-3984 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 20/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1158739 | (05) | LA |
1E7268 | MEDICARE ID (01) | LA |
H87340 | (02) | LA |