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General NPI Number Information
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NPI Number | 1639331283
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Entity Type | Organization
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Legal Business Name | DHARAM P GURWARA APMC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 6047 FIVE OAKS DR SUITE D
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City | SHREVEPORT
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State | LA
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Zip | 71129-2596
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Country | US
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Telephone | 318-752-2890
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Fax | 318-752-2890
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Provider Business Mailing Address
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Address Line | PO BOX 5027
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City | BOSSIER CITY
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State | LA
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Zip | 71171-5027
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Country | US
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Telephone | 318-752-2890
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Fax | 318-752-2890
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Authorized Official
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Title or Position | MD OWNER
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Name | DHARAM PRAKASH GURWARA
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Credential | M.D
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Telephone | 318-752-2890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 017034
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 017034
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License Number State | LA
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