Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 16167 | LA |
NPI | 1013906320 |
---|---|
Provider Name | Dr. Vernon J Carriere |
First Address | Metairie, LA 70001-1234 |
Second Address | Metairie, LA 70001-1234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 02/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366773 | (05) | LA |
B63246 | (02) | |
F8575 | BCBS OF LA (01) | LA |