Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | LA5084 | LA |
NPI | 1194996637 |
---|---|
Provider Name | Richard Tipery Akin |
First Address | Baton Rouge, LA 70806-6534 |
Second Address | Baton Rouge, LA 70806-6534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2008 |
Last Update Date | 08/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1850845 | (05) | LA |
I24591 | (02) | LA |