Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 01037740A | IN |
NPI | 1003818626 |
---|---|
Provider Name | Lawrence John Born |
First Address | Indianapolis, IN 46260-5918 |
Second Address | Indianapolis, IN 46260-5918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 23/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F81837 | (02) |