Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 257340 | NY |
Y | 207P00000X | Emergency Physician | MD.205118 | LA |
NPI | 1013153444 |
---|---|
Provider Name | Lisa Birdsall Fort |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121-2429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2009 |
Last Update Date | 05/09/2017 |