Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | A122626 | CA |
NPI | 1033312608 |
---|---|
Provider Name | Dr. Robert George Louis JR. |
First Address | Newport Beach, CA 92663-4093 |
Second Address | Newport Beach, CA 92663-4093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2007 |
Last Update Date | 02/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CB227900 | MEDICARE PTAN - GROUP (01) | CA |
CB227901 | MEDICARE PTAN - INDIVIDUAL (01) | CA |