Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2578 | LA |
NPI | 1033292008 |
---|---|
Provider Name | Michael Delano Daigle |
First Address | Houma, LA 70360 |
Second Address | Houma, LA 70360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 09/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1825786 | (05) | LA |
T19737 | (02) |