| NPI | 1952878506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI LYNN CLARDY Credentialing Specialist 225-570-2489 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RG0100X Internal Medicine, Gastroenterology |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2020-01-27 |