Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | PDO64R | LA |
Y | 222Z00000X | Podiatrist | PDO64R | LA |
N | 213EP1101X | Primary Podiatric Medicine | DPMPDO64R | LA |
N | 111NR0200X | Radiology | DPMPDO64R | LA |
N | 213ER0200X | Radiology | DPMPDO64R | LA |
N | 2081S0010X | Sports Medicine | DPMPDO64R | LA |
N | 213ES0000X | Sports Medicine | DPMPDO64R | LA |
N | 213ES0103X | Foot & Ankle Surgery | DPMPDO64R | LA |
N | 213ES0131X | Foot Surgery | DPMPDO64R | LA |
NPI | 1447214143 |
---|---|
Provider Name | Mr. Angelo Paul Morreale |
First Address | Shreveport, LA 71135-2313 |
Second Address | Shreveport, LA 71106-7232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 27/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1905801 | (05) | LA |
T19729 | (02) |