Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | LA9380 | LA |
NPI | 1013995091 |
---|---|
Provider Name | Kenneth C. Cranor |
First Address | Baton Rouge, LA 70808-4273 |
Second Address | Baton Rouge, LA 70808-9168 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1090077 | (05) | LA |
B63391 | (02) | LA |