Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD 202357 | LA |
N | 111NI0900X | Internist | MD 202357 | LA |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 54456 | MN |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD 202357 | LA |
NPI | 1073772331 |
---|---|
Provider Name | Dr. Zhen Jiao |
First Address | Metairie, LA 70006-2936 |
Second Address | Metairie, LA 70006-2936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 23/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |