Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 310054 | LA |
NPI | 1245626910 |
---|---|
Provider Name | Latrice Roberts |
First Address | Rayville, LA 71269-3624 |
Second Address | Rayville, LA 71269-3624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 11/03/2020 |