Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 13289R | LA |
N | 111NI0900X | Internist | 13289R | LA |
N | 207RA0401X | Internist - Addiction Medicine | 13289R | LA |
Y | 207RH0002X | Hospice and Palliative Medicine | 13289R | LA |
NPI | 1528063252 |
---|---|
Provider Name | Richard Thomas Sipes |
First Address | Shreveport, LA 71106-6107 |
Second Address | Shreveport, LA 71106-6107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2005 |
Last Update Date | 15/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1578827 | (05) | LA |
385661030D | BCBS (01) | LA |
H26657 | (02) |