is a Plastic Surgery in Shreveport, Louisiana. practices all healthcare services and medical treatments related to Plastic Surgery. The NPI Number for is 1033269303. The last update date is .
's current location address is 1512 W Kirby Pl, Shreveport, Louisiana. You can contact this provider via phone number 3186757636. The mailing address for is 1512 W Kirby Pl, Shreveport, Louisiana. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 1512 W Kirby Pl, Shreveport, Louisiana |
| Phone Number | 3186757636 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1033269303 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 1512 W Kirby Pl |
|---|---|
| City | Shreveport |
| State | Louisiana (LA) |
| Post Code | 711033822 |
| Phone Number | 3186757636 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Plastic Surgery |
|---|---|
| Taxonomy | 208200000X |
| Licence No | N3553 |
|
Definition: A plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or c |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 2324209 | TX | -- | |
| 276655YH54 | LA | MEDICARE - PTAN |
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