Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01086534A | IN |
N | 207Q00000X | Family Doctor | A159360 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | A159360 | CA |
N | 207QS0010X | Family Doctor - Sports Medicine | T3505 | TX |
NPI | 1306374764 |
---|---|
Provider Name | George T Le |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Greenwood, IN 46142-1400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2017 |
Last Update Date | 17/12/2021 |