Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 025130 | LA |
NPI | 1003820721 |
---|---|
Provider Name | Dr. Stacy Greene |
First Address | New Orleans, LA 70131-3336 |
Second Address | Gretna, LA 70056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 26/05/2011 |