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General NPI Number Information
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NPI Number | 1093776429
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Entity Type | Organization
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Legal Business Name | BUNDRICK AND O'NEAL PLASTIC SURGERY (AMC)
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 06/27/2022
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Provider Practice Location Address
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Address Line | 2210 LINE AVE SUITE 204
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City | SHREVEPORT
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State | LA
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Zip | 71104-2152
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Country | US
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Telephone | 318-221-9671
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Fax | 318-425-2343
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Provider Business Mailing Address
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Address Line | 2210 LINE AVE SUITE 204
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City | SHREVEPORT
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State | LA
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Zip | 71104-2152
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Country | US
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Telephone | 318-221-9671
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Fax | 318-425-2343
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JILL PATTERSON
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Credential |
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Telephone | 318-221-9671
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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