Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 4301046678 | MI |
NPI | 1003929845 |
---|---|
Provider Name | Mr. Barry L Laughlin |
First Address | Haslett, MI 48840 |
Second Address | Haslett, MI 48840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3231048 | (05) | MI |
6600006 | PHP (01) | |
7388025 | AETNA (01) | |
B43123 | (02) |