Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3445 | LA |
NPI | 1033142872 |
---|---|
Provider Name | Edward A Neupert III |
First Address | Lafayette, LA 70506 |
Second Address | Lafayette, LA 70506-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 06/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1834459 | (05) | LA |
U34680 | (02) | LA |