| NPI | 1760939987 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG J GAVIN Managed Care Credentialing 318-212-8951 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207KI0005X Allergy & Immunology, Clinical & Laboratory Immunology |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2019-04-03 |