Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 018992 | LA |
NPI | 1063465813 |
---|---|
Provider Name | Michael V. St. Romain |
First Address | Zachary, LA 70791-0311 |
Second Address | Marksville, LA 71351-4711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 15/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1373621 | (05) | LA |
D84451 | (02) | LA |