Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | MD202152 | LA |
NPI | 1417167750 |
---|---|
Provider Name | Markus Vattakattil John |
First Address | Baton Rouge, LA 70816-0416 |
Second Address | Baton Rouge, LA 70816-0416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 07/01/2016 |