Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 71666 | GA |
Y | 2080P0214X | Pediatric Pulmonologist | 310171 | LA |
NPI | 1477796258 |
---|---|
Provider Name | Timothy C. Beaty |
First Address | New Orleans, LA 70121-2429 |
Second Address | New Orleans, LA 70121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2009 |
Last Update Date | 06/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003145693A | (05) | GA |
1913642 | (05) | LA |