Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 010342 | LA |
NPI | 1104815612 |
---|---|
Provider Name | John R Clifford |
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 | 18/10/2005 |
Last Update Date | 27/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1121533 | (05) | LA |
B62723 | (02) | LA |