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 |