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General NPI Number Information
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NPI Number | 1790705093
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Entity Type | Individual
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Provider Name | NELSON DARIO LURAGUIZ M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2011
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Provider Practice Location Address
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Address Line | 1501 KINGS HWY DEPARTMENT OF RADIOLOGY
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City | SHREVEPORT
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State | LA
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Zip | 71103-4228
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Country | US
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Telephone | 318-675-7737
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Fax | 318-675-5666
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Provider Business Mailing Address
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Address Line | 1512 W KIRBY PL DEPARTMENT OF RADIOLOGY
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City | SHREVEPORT
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State | LA
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Zip | 71103-3822
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Country | US
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Telephone | 318-675-7636
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Fax | 318-675-7531
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 15649R
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License Number State | LA
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