Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD.015116 | LA |
NPI | 1497709307 |
---|---|
Provider Name | Harold G Bienvenu III |
First Address | New Iberia, LA 70560-3876 |
Second Address | New Iberia, LA 70560-3876 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B61455 | (02) | LA |