Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 1694 | LA |
NPI | 1740209139 |
---|---|
Provider Name | William A Couvillion |
First Address | Baton Rouge, LA 70806-8203 |
Second Address | Baton Rouge, LA 70806-8203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |