Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 09701R | LA |
N | 2081P2900X | Pain Medicine | 09701R | LA |
NPI | 1124017298 |
---|---|
Provider Name | Scott D Nyboer |
First Address | Baton Rouge, LA 70884-9509 |
Second Address | Baton Rouge, LA 70810-1686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2005 |
Last Update Date | 01/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1968111 | (05) | LA |
F57250 | (02) | LA |