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General NPI Number Information
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NPI Number | 1770809238
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Entity Type | Organization
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Legal Business Name | PROMAS LLC
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 07/09/2018
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Provider Practice Location Address
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Address Line | 1453 E BERT KOUNS INDUSTRIAL LOOP
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 318-681-4126
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 52078
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City | SHREVEPORT
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State | LA
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Zip | 71135-2078
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Country | US
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Telephone | 800-828-9227
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Fax | 318-861-4724
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROSCOE HO-KEUNG CHAN
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Credential |
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Telephone | 318-681-4126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 014269R
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License Number State | LA
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