Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 122 | LA |
NPI | 1104894591 |
---|---|
Provider Name | Frank Leslie Pegues |
First Address | Baton Rouge, LA 70806-6318 |
Second Address | Baton Rouge, LA 70806-6318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T19949 | (02) | LA |