Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | MD03340R | LA |
NPI | 1114913795 |
---|---|
Provider Name | Terry Randall Jones |
First Address | Baton Rouge, LA 70808-4197 |
Second Address | Independence, LA 70443-2231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B60714 | (02) |