Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01043611A | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 01043611A | IN |
N | 207R00000X | Internist | 01043611A | IN |
N | 111NI0900X | Internist | 01043611A | IN |
Y | 207RG0300X | Geriatric Medicine | 01043611A | IN |
NPI | 1306999206 |
---|---|
Provider Name | Laurence Waln Behney |
First Address | Beech Grove, IN 46107-0100 |
Second Address | Beech Grove, IN 46107-1541 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 31/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000027961 | M PLAN (01) | IN |
000000341213 | ANTHEM (01) | IN |
01043611B | CSR (01) | IN |
10780253 | CAQH (01) | IN |
AB3293456 | DEA (01) | IN |
B21178 | (02) | IN |