Healthcare Provider Details

I. General information

NPI: 1780642512
Provider Name (Legal Business Name): GERALD ANDREW DZURIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 EAST 70TH ST
SHREVEPORT LA
71105
US

IV. Provider business mailing address

1819 EAST 70TH ST
SHREVEPORT LA
71105
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-6601
  • Fax: 318-797-5999
Mailing address:
  • Phone: 318-797-6601
  • Fax: 318-797-5999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number012157
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: