# SHREVEPORT INTERNAL MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700838513
- **Authorized official:** DR. RICHARD E. HAYNIE M.D. (PRESIDENT)
- **Authorized official phone:** (318) 621-2929

## Contact information

- **Practice address:** 1449 E BERT KOUNS INDUSTRIAL LOOP, SUITE 100, SHREVEPORT, LA 71105-5634
- **Practice address phone:** (318) 629-0220
- **Mailing address:** 1449 E BERT KOUNS INDUSTRIAL LOOP, SUITE 100, SHREVEPORT, LA 71105-5634
- **Mailing address phone:** (318) 629-0220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | LA | Yes |

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 07/21/2022