Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 3496 | NV |
NPI | 1043216500 |
---|---|
Provider Name | Paul C Ludlow |
First Address | Reno, NV 89521-1907 |
Second Address | Reno, NV 89502-1469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002016138 | (05) | NV |
C96286 | (02) |