Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 05703R | LA |
NPI | 1134190465 |
---|---|
Provider Name | Ralph W Colpitts |
First Address | Lake Charles, LA 70605-4138 |
Second Address | Lake Charles, LA 70605-4138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 05/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1330663 | (05) | LA |
B63303 | (02) | LA |