Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1205305075 |
---|---|
Provider Name | Paul Lanciault |
First Address | Temple, TX 76504-7451 |
Second Address | Temple, TX 76504-7451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2018 |
Last Update Date | 21/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CPO03232 | AMERICAN BOARD FOR CERTIFICATION IN ORTHOTICS, PROSTHETICS & PEDORTHICS (01) |