Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD.206019 | LA |
NPI | 1003106584 |
---|---|
Provider Name | Mark Makoto Fujita |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70114-8216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2011 |
Last Update Date | 15/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03281828 | (05) | MS |
2150197 | (05) | LA |