| 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 |