Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 04671 | RI |
NPI | 1124002019 |
---|---|
Provider Name | Toussaint Andre Leclercq |
First Address | Lincoln, RI 02865-2905 |
Second Address | Lincoln, RI 02865-2905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2005 |
Last Update Date | 29/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C90712 | (02) | RI |