Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD.200296 | LA |
N | 207PE0004X | Emergency Medical Services | 25550 | MS |
NPI | 1023197142 |
---|---|
Provider Name | Ujwal Meka |
First Address | Slidell, LA 70458-3147 |
Second Address | Picayune, MS 39466-2835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007918178 | DRIVER LICENSE (01) | LA |