Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 026336 | LA |
N | 208000000X | Pediatrician | 026336 | LA |
NPI | 1659371409 |
---|---|
Provider Name | Dr. Tara Hooper Ryan |
First Address | Baton Rouge, LA 70809-3489 |
Second Address | Baton Rouge, LA 70809-3489 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 04/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1159123 | (05) | LA |
247622YJJ3 | MEDICARE (01) | |
H94425 | (02) | LA |