Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 015167 | LA |
NPI | 1053465005 |
---|---|
Provider Name | Michael Lester Lifsey |
First Address | Metairie, LA 70001-1224 |
Second Address | Metairie, LA 70001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 18/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1341673 | (05) | LA |
D04131 | (02) |