Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD.014468 | LA |
N | 207RP1001X | Pulmonary Disease | 036-114723 | IL |
NPI | 1023052024 |
---|---|
Provider Name | Robert Larimer |
First Address | Alexandria, LA 71301 |
Second Address | Alexandria, LA 71301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 01/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1323381 | (05) | LA |
5L154 | MEDICARE - PTAN (01) | LA |
B61219 | (02) |