Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PD162R | LA |
NPI | 1083893267 |
---|---|
Provider Name | Robert B Kirton |
First Address | Ruston, LA 71270-2804 |
Second Address | Ruston, LA 71270-2804 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 18/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1657212 | (05) | LA |