Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 017225 | LA |
NPI | 1093779092 |
---|---|
Provider Name | Dr. Walter L Bringaze III |
First Address | Baton Rouge, LA 70808-4300 |
Second Address | Baton Rouge, LA 70808-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 22/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00111813 | (05) | MS |
1354716 | (05) | LA |
B65211 | (02) | LA |