Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | 030557 | GA |
NPI | 1871517979 |
---|---|
Provider Name | Larry B Vogler |
First Address | Atlanta, GA 30322-1014 |
Second Address | Atlanta, GA 30322-1014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
649740 | BLUE CROSS BLUE SHIELD (01) | GA |
B04317 | (02) |