Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 00207 | LA |
NPI | 1003920422 |
---|---|
Provider Name | Ms. Freddie Ann Regan |
First Address | Lake Charles, LA 70601 |
Second Address | Lake Charles, LA 70601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 27/09/2007 |