Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 303248 | LA |
NPI | 1003251356 |
---|---|
Provider Name | Krunal Patel |
First Address | Zachary, LA 70791-4092 |
Second Address | Zachary, LA 70791-4092 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2013 |
Last Update Date | 02/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2402561 | (05) | LA |