Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 55735 | MA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 55735 | MA |
NPI | 1144203472 |
---|---|
Provider Name | J. Robert Larrieux |
First Address | Boston, MA 02118-2371 |
Second Address | Boston, MA 02118-2371 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 28/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110043988A | (05) | MA |