Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 11117 | GA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4912 | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 024422 | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 51272 | GA |
NPI | 1194731836 |
---|---|
Provider Name | James William Sikes JR. |
First Address | Shreveport, LA 71105-4176 |
Second Address | Shreveport, LA 71105-4176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 20/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1467912 | UCCI (01) | LA |
1849120 | (05) | LA |
H39414 | (02) | LA |