Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 015579 | LA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 15579 | LA |
NPI | 1619969342 |
---|---|
Provider Name | James S Lillich |
First Address | Shreveport, LA 71101-4531 |
Second Address | Shreveport, LA 71101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 31/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B62059 | (02) | LA |