Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 10309R | LA |
N | 2081P2900X | Pain Medicine | 10309R | LA |
NPI | 1104816115 |
---|---|
Provider Name | John E Nyboer |
First Address | Baton Rouge, LA 70884-9509 |
Second Address | Baton Rouge, LA 70810-1686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 01/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1986356 | (05) | LA |
F60419 | (02) | LA |