Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | L#011678 | LA |
NPI | 1104829613 |
---|---|
Provider Name | Samuel Richard Staggers |
First Address | Hammond, LA 70403-1446 |
Second Address | Hammond, LA 70403-1446 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2005 |
Last Update Date | 22/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1188158 | (05) | LA |
B88988 | (02) | LA |