Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | PD179R | LA |
NPI | 1235243767 |
---|---|
Provider Name | Dr. Sheila D. Washington |
First Address | Shreveport, LA 71105-2707 |
Second Address | Shreveport, LA 71101-4243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T75527 | (02) | LA |