Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | L016281 | LA |
NPI | 1003898362 |
---|---|
Provider Name | Robin Ann Rougeau |
First Address | Lake Charles, LA 70601 |
Second Address | Lake Charles, LA 70601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1353574 | (05) | LA |
B62483 | (02) |