Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 12887 | AL |
NPI | 1063443745 |
---|---|
Provider Name | Mr. Lee Headley Loftin |
First Address | Tuscaloosa, AL 35406-2283 |
Second Address | Tuscaloosa, AL 35406-2283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C17240 | (02) |