Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD204029 | LA |
NPI | 1093974099 |
---|---|
Provider Name | Dr. Taylor Scott Gwin |
First Address | Baton Rouge, LA 70809-3679 |
Second Address | Baton Rouge, LA 70809-3679 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2008 |
Last Update Date | 22/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1092231 | (05) | LA |
417361ZPPR | (02) | LA |