Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 15492R | LA |
NPI | 1518923317 |
---|---|
Provider Name | John B Lopoo JR. |
First Address | Baton Rouge, LA 70809-3481 |
Second Address | Baton Rouge, LA 70809-3481 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 25/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1460621 | (05) | LA |
G62202 | (02) | LA |