| NPI | 1558393371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG J GAVIN Network Administrator 318-221-1001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2012-06-08 |