| NPI | 1235523002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG J GAVIN Network Administrator 318-212-8780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2015-10-27 |