# SOUTHSIDE FOOT CLINIC OF SHREVEPORT, INC. A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Southside Foot Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033111240
- **Authorized official:** MR. RICHARD TAYLOR HAVENS D.P.M. (PHYSICIAN/ADMINISTRATOR)
- **Authorized official phone:** (318) 687-6266

## Contact information

- **Practice address:** 9308 MANSFIELD RD, STE 100, SHREVEPORT, LA 71118-3134
- **Practice address phone:** (318) 687-6266
- **Practice address fax:** (318) 683-1023
- **Mailing address:** 9308 MANSFIELD RD, STE 100, SHREVEPORT, LA 71118-3134
- **Mailing address phone:** (318) 687-6266
- **Mailing address fax:** (318) 683-1023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | 5B496 | LA | Yes |

## Other

- **Enumeration date:** 06/01/2005
- **Last updated:** 12/29/2025