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General NPI Number Information
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NPI Number | 1750697314
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Entity Type | Organization
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Legal Business Name | PLASTIC SURGERY OF SHREVEPORT, INC
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 1666 E BERT KOUNS LOOP STE 145
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City | SHREVEPORT
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State | LA
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Zip | 71105-5714
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Country | US
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Telephone | 318-797-9199
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Fax | 319-797-9193
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Provider Business Mailing Address
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Address Line | 1666 EAST BERT KOUNS INS LOOP STE 145
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City | SHREVEPORT
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State | LA
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Zip | 71105-5718
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Country | US
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Telephone | 318-797-9199
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Fax | 319-797-9193
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL M DAVIS
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Credential | MD
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Telephone | 318-797-9199
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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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