Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 007934 | LA |
N | 207U00000X | Nuclear Medicine Specialist | 07455 | MS |
NPI | 1679673891 |
---|---|
Provider Name | Terence Beven |
First Address | Baton Rouge, LA 70808-4300 |
Second Address | Baton Rouge, LA 70808-4375 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2006 |
Last Update Date | 21/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1317039 | (05) | LA |
B62364 | (02) | LA |