Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 020465 | LA |
NPI | 1083683601 |
---|---|
Provider Name | Gregory Duplechain |
First Address | Lafayette, LA 70505-2068 |
Second Address | Lafayette, LA 70508-8800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2006 |
Last Update Date | 17/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1982229 | (05) | LA |
F89762 | (02) |