MEDICARE: PULMONARY MEDICINE ASSOCIATES

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	207RP1001X	Pulmonary Disease Physician

General Provider Information

NPI Number	:	1821129560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY MEDICINE ASSOCIATES

Provider Business Mailing Address
First Line	:	850 OLIVE ST
Second Line	:	SUITE A
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2162
Country	:	US
Telephone Number	:	318-222-3662
Fax Number	:	318-222-0034

Provider Business Practice Location Address
First Line	:	850 OLIVE ST
Second Line	:	SUITE A
City	:	SHREVEPORT
State	:	LA
Zip	:	71104-2162
Country	:	US
Telephone Number	:	318-222-3662
Fax Number	:	318-222-0034

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LOYD WHITLEY
Credential	:
Telephone Number	:	318-230-8505

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/19/2010

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