Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 200029 | LA |
NPI | 1093704181 |
---|---|
Provider Name | Jyoti S Pham |
First Address | Baton Rouge, LA 70884-9509 |
Second Address | Baton Rouge, LA 70810-1686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 28/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1621803 | (05) | LA |
I31123 | (02) | LA |