Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | PD264R | LA |
NPI | 1396774824 |
---|---|
Provider Name | Joseph Paul Dileo |
First Address | Hammond, LA 70403 |
Second Address | Hammond, LA 70403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 20/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1120707 | (05) | LA |
28584 | LA CONTROL # (01) | LA |
7289375 | AETNA US HEALTHCARE (01) | LA |
PD264R | DPM LICENSE # (01) | LA |
U90873 | (02) | LA |