Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 018991 | LA |
NPI | 1184678997 |
---|---|
Provider Name | Mark A. St. Cyr |
First Address | Lafayette, LA 70501-8556 |
Second Address | Lafayette, LA 70501-8556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 15/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1365963 | (05) | LA |
D84421 | (02) | LA |