Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 201689 | LA |
N | 2080P0203X | Pediatric Critical Care Doctor | 201689 | LA |
NPI | 1205006111 |
---|---|
Provider Name | Mrs. Melissa Haggerty Roy |
First Address | Baton Rouge, LA 70808-4363 |
Second Address | Baton Rouge, LA 70808-4363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2008 |
Last Update Date | 03/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1508276 | (05) | LA |