| NPI | 1396082632 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI DAVIDSON BEAVERS Credentialing Manager 318-325-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 05708R) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2013-01-07 |