Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MD.018089 | LA |
NPI | 1043219140 |
---|---|
Provider Name | Rebecca Adair Clark |
First Address | New Orleans, LA 70119-7100 |
Second Address | New Orleans, LA 70119-7100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00125805 | (05) | MS |
1392847 | (05) | LA |
E28136 | (02) |