Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 301449 | LA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 301449 | LA |
N | 2086S0105X | Surgery of the Hand | 301449 | LA |
NPI | 1376860148 |
---|---|
Provider Name | Mark Tyson Garon |
First Address | Baton Rouge, LA 70898-9035 |
Second Address | Baton Rouge, LA 70808-4794 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2010 |
Last Update Date | 20/10/2017 |