| NPI | 1730636861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DODSON Billing Manager 318-473-9556 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: LA 9317843) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2021-04-26 |