Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD.015745 | LA |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD015745 | LA |
NPI | 1205925070 |
---|---|
Provider Name | Dr. Ronald D. Sylvest |
First Address | Baton Rouge, LA 70808 |
Second Address | Baton Rouge, LA 70808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 17/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1360511 | (05) | LA |
B63191 | (02) | LA |