Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME104707 | FL |
N | 111NI0900X | Internist | ME104707 | FL |
N | 207RG0300X | Geriatric Medicine | MD203694 | LA |
N | 207RH0002X | Hospice and Palliative Medicine | MD203694 | LA |
Y | 207RH0003X | Hematology & Oncology | MD203694 | LA |
NPI | 1346475506 |
---|---|
Provider Name | Dr. Shibu Varughese |
First Address | Gretna, LA 70056-7057 |
Second Address | Gretna, LA 70056-7057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2009 |
Last Update Date | 14/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2107780 | (05) | LA |
4Q908DX34 | (02) | LA |
CQ321Z | (02) | FL |