Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | GETP | LA |
NPI | 1003084617 |
---|---|
Provider Name | Dr. Roderick A. Hart SR. |
First Address | Baton Rouge, LA 70806-3825 |
Second Address | Baton Rouge, LA 70806-3825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2008 |
Last Update Date | 08/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1091774 | (05) | LA |
1-09177-4 | (05) | LA |
P00775057 | RAILROAD MCARE THRU PEPA (01) | LA |