| NPI | 1407411838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | M LAWRENCE DRERUP Manager 318-443-4576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207T00000X Neurological Surgery |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2019-05-01 |