Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G069197 | CA |
N | 111NI0900X | Internist | G069197 | CA |
N | 207R00000X | Internist | ME0070878 | FL |
N | 111NI0900X | Internist | ME0070878 | FL |
Y | 207U00000X | Nuclear Medicine Specialist | 13364R | LA |
N | 207U00000X | Nuclear Medicine Specialist | 16977 | MS |
NPI | 1477653673 |
---|---|
Provider Name | Elizabeth Denise Gallegos |
First Address | Baton Rouge, LA 70808-4300 |
Second Address | Baton Rouge, LA 70808-4375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 21/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1568741 | (05) | LA |
G36396 | (02) | LA |