Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 204200 | LA |
NPI | 1003083205 |
---|---|
Provider Name | Walker May |
First Address | Vivian, LA 71082-3100 |
Second Address | Vivian, LA 71082-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2008 |
Last Update Date | 21/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
06227 | (05) | LA |
1038130 | (05) | LA |
1062278 | (05) | LA |