Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 03480R | LA |
NPI | 1851397855 |
---|---|
Provider Name | Robert S. Thornton |
First Address | Shreveport, LA 71104-2126 |
Second Address | Shreveport, LA 71104-2126 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2005 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1171662 | (05) | LA |
B60975 | (02) |