Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 011448 | LA |
N | 204C00000X | Sports Medicine Doctor | 11448 | LA |
NPI | 1821080383 |
---|---|
Provider Name | Lewis C Jones |
First Address | Shreveport, LA 71105-4166 |
Second Address | Shreveport, LA 71105-4166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 29/11/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B60479 | (02) | |
B60493 | (02) | LA |