Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 010625 | LA |
NPI | 1083615652 |
---|---|
Provider Name | Dr. Robert L. Guy |
First Address | Harvey, LA 70058 |
Second Address | Marrero, LA 70072-4338 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1118788 | (05) | LA |