Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 15751R | LA |
Y | 2086S0129X | Vascular Surgeon | MD.15751R | LA |
NPI | 1093726515 |
---|---|
Provider Name | Malachi G. Sheahan, Iii III |
First Address | New Orleans, LA 70112-1221 |
Second Address | Marrero, LA 70072-3151 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 08/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07776804 | (05) | MS |
1468088 | (05) | LA |
I00592 | (02) |