Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 014162 | LA |
NPI | 1285623561 |
---|---|
Provider Name | Thomas A. Hansbrough |
First Address | Baton Rouge, LA 70810-7827 |
Second Address | Baton Rouge, LA 70810-7827 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 17/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1300969 | (05) | LA |
B61159 | (02) | LA |