Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 019093 | LA |
NPI | 1083614879 |
---|---|
Provider Name | Ileana J Tandron |
First Address | Slidell, LA 70461-4231 |
Second Address | Slidell, LA 70461-4231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 12/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1369888 | (05) | LA |