NPI | 1982962445 |
---|---|
Entity Type | Organization |
Authorized Contact | KELLI D BEAVERS Credentialing Manager 318-325-6200 |
Organization Subpart ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: LA md.010913) |
Enumeration Date | 2012-05-02 |
Last Update Date | 2012-11-27 |