Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 010599 | LA |
NPI | 1053308692 |
---|---|
Provider Name | Tom J Meek JR. |
First Address | Baton Rouge, LA 70808-4388 |
Second Address | Baton Rouge, LA 70808-4388 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2005 |
Last Update Date | 07/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1130559 | (05) | LA |
B64671 | (02) |