Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 19703 | NE |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 19703 | NE |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | J6540 | TX |
NPI | 1750431755 |
---|---|
Provider Name | Pierre J Lavedan |
First Address | Garland, TX 75042-5755 |
Second Address | Garland, TX 75042-5755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 07/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3475493-01 | (05) | TX |