Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | 8634 | LA |
NPI | 1073625505 |
---|---|
Provider Name | Mr. George Allan Farber SR. |
First Address | Kenner, LA 70065-3031 |
Second Address | Kenner, LA 70065-3031 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 03/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1115037 | (05) | LA |
B63463 | (02) | LA |