Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | MD.025221 | LA |
NPI | 1013949619 |
---|---|
Provider Name | Matti W Palo JR. |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Covington, LA 70433-8103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 22/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04233229 | (05) | MS |
1572713 | (05) | LA |
H82676 | (02) |