Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 14687 | AL |
N | 204E00000X | Oral & Maxillofacial Surgeon | 14687 | AL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | D.4395 | AL |
NPI | 1124096003 |
---|---|
Provider Name | Patrick J Louis |
First Address | Birmingham, AL 35255-5310 |
Second Address | Birmingham, AL 35249-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2006 |
Last Update Date | 07/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000081544 | (05) | AL |
000081544 | BLUE CROSS (01) | AL |
009944485 | (05) | AL |
009944495 | (05) | AL |
009944505 | (05) | AL |
051090895 | BLUE CROSS (01) | AL |
051520050 | BLUE CROSS (01) | AL |
051520051 | BLUE CROSS (01) | AL |
E22985 | (02) | AL |