Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 016869 | LA |
NPI | 1003891433 |
---|---|
Provider Name | Mr. James G Ralston |
First Address | Pineville, LA 71360-8428 |
Second Address | Pineville, LA 71360-8428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 16/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1367494 | (05) | LA |
B64202 | (02) |