Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2193 | LA |
NPI | 1083676415 |
---|---|
Provider Name | Richard R Brasher JR. |
First Address | Alexandria, LA 71301-3451 |
Second Address | Alexandria, LA 71301-3451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2006 |
Last Update Date | 20/03/2014 |