Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003397 |
NPI | 1144473224 |
---|---|
Provider Name | Mr. Gaylord Collins |
First Address | Pineville, LA 71360-2006 |
Second Address | Pineville, LA 71306-9004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2008 |
Last Update Date | 03/11/2008 |