Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 205991 | LA |
N | 208200000X | Surgeon | N3553 | TX |
N | 208600000X | Surgeon | N3553 | TX |
N | 2086S0105X | Surgery of the Hand | 205991 | LA |
NPI | 1033269303 |
---|---|
Provider Name | Marjorie R Chelly |
First Address | Shreveport, LA 71103-3822 |
Second Address | Shreveport, LA 71103-4228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 21/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2324209 | (05) | TX |
276655YH54 | MEDICARE - PTAN (01) | LA |