Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 01081051A | IN |
NPI | 1023229317 |
---|---|
Provider Name | Jose Luis Carrau Lebron |
First Address | Mary Esther, FL 32569-0183 |
Second Address | Tulsa, OK 74104-5644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 29/12/2021 |