Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 018539 | LA |
NPI | 1104836436 |
---|---|
Provider Name | Robert Keith White |
First Address | Monroe, LA 71201-4732 |
Second Address | Monroe, LA 71201-7457 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 11/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1972193 | (05) | LA |
F69168 | (02) | LA |