Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | MD.011028 | LA |
NPI | 1306879317 |
---|---|
Provider Name | Lynn R Witherspoon |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121-2429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 14/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1164704 | (05) | LA |
B61652 | (02) |