Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 08677R | LA |
NPI | 1013910801 |
---|---|
Provider Name | Dr. William R Condos JR. |
First Address | Lake Charles, LA 70601-8990 |
Second Address | Lake Charles, LA 70601-8990 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 04/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1915823 | (05) | LA |
E86706 | (02) | LA |