Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 244454 | NY |
N | 208600000X | Surgeon | 244454 | NY |
Y | 2086S0120X | Pediatric Surgery | MD.207225 | LA |
N | 2086S0120X | Pediatric Surgery | MD434879 | PA |
NPI | 1114186921 |
---|---|
Provider Name | Jessica Lynn Roybal |
First Address | New Orleans, LA 70121 |
Second Address | New Orleans, LA 70121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 17/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08482329 | (05) | MS |
2373854 | (05) | LA |