Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 015291 | LA |
NPI | 1063578011 |
---|---|
Provider Name | Oliver Roy Lambert |
First Address | La Place, LA 70068-5400 |
Second Address | La Place, LA 70068-5400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 11/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015291 | LICENSE NUMBER (01) | LA |
1324906 | (05) | LA |
D84430 | (02) | LA |