Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 302879 | LA |
Y | 208600000X | Surgeon | 302879 | LA |
NPI | 1013209329 |
---|---|
Provider Name | Mark Andrew Sicard |
First Address | Opelousas, LA 70571-2118 |
Second Address | Opelousas, LA 70570-6494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 02/08/2016 |