Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 308686 | LA |
NPI | 1023429685 |
---|---|
Provider Name | Dr. Shalimar Small |
First Address | Baton Rouge, LA 70806-4019 |
Second Address | New Orleans, LA 70112-1349 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2014 |
Last Update Date | 21/09/2018 |