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General NPI Number Information
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NPI Number | 1285957811
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Entity Type | Organization
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Legal Business Name | PAIR O' DOCS BIO-REJUVENIS
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Dates
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Enumeration Date | 03/10/2010
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Last Update Date | 03/10/2010
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Provider Practice Location Address
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Address Line | 6030 LINE AVE SUITE 210
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City | SHREVEPORT
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State | LA
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Zip | 71106-2062
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Country | US
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Telephone | 318-550-0050
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Fax | 318-550-0053
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Provider Business Mailing Address
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Address Line | 6030 LINE AVE SUITE 210
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City | SHREVEPORT
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State | LA
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Zip | 71106-2062
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Country | US
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Telephone | 318-550-0050
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Fax | 318-550-0053
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAREN M'LISS PENDLETON
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Credential | MD
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Telephone | 318-550-0050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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