Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 203722 | LA |
NPI | 1174662936 |
---|---|
Provider Name | John Christian Hildenbrand IV |
First Address | Thibodaux, LA 70302-0028 |
Second Address | Thibodaux, LA 70301-5009 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 11/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012939 | (05) | LA |