MEDICARE: GENTRY HAUGHTON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	200048	LA

General Provider Information

NPI Number	:	1245503119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENTRY HAUGHTON LLC

Provider Business Mailing Address
First Line	:	PO BOX 5237
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71135-5237
Country	:	US
Telephone Number	:	318-519-7555
Fax Number	:

Provider Business Practice Location Address
First Line	:	592 UNADILLA ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-1240
Country	:	US
Telephone Number	:	318-519-7555
Fax Number	:

Authorized Official
Title or Position	:	PODIATRIST
Name	:	DR. GENTRY LEE HAUGHTON
Credential	:	DPM
Telephone Number	:	318-519-7555

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	07/18/2024

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Directions to “GENTRY HAUGHTON LLC ” Practice Location

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