| NPI | 1740548361 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI D. BEAVERS Credentialing Manager 318-325-6200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA MD.025610) |
| Enumeration Date | 2012-05-02 |
| Last Update Date | 2012-05-02 |