Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 016313 | LA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 016313 | LA |
NPI | 1407883820 |
---|---|
Provider Name | Samuel K Abshire |
First Address | Haynesville, LA 71038-6100 |
Second Address | Haynesville, LA 71038-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 14/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110320001 | (05) | AR |
1336491 | (05) | LA |
50348C739 | (02) | LA |
B62336 | (02) | LA |