Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 015663 | LA |
NPI | 1003881616 |
---|---|
Provider Name | Gregory Fusilier |
First Address | Baton Rouge, LA 70809-2440 |
Second Address | Baton Rouge, LA 70809-2440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 24/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B61542 | (02) | LA |