| NPI | 1811948037 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MIKE BREARD Vice President 318-361-0900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics Adolescent Medicine |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2011-07-05 |