Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 033672 | GA |
N | 207V00000X | Obstetrician & Gynecologist | 205673 | LA |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 205673 | LA |
NPI | 1295721462 |
---|---|
Provider Name | Lisa Marie Peacock |
First Address | New Orleans, LA 70115-4637 |
Second Address | New Orleans, LA 70115-4637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2005 |
Last Update Date | 23/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F31619 | (02) |