# SHREVEPORT INTERNAL MEDICINE AND PEDIATRICS LLC

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

## Provider details

- **NPI number:** 1710041900
- **Authorized official:** ALLAN S MATRIANO LIM MD (OWNER)
- **Authorized official phone:** (318) 588-0880

## Contact information

- **Practice address:** 10401 E KINGS HWY, SHREVEPORT, LA 71115-3227
- **Practice address phone:** (318) 558-0880
- **Practice address fax:** (318) 562-6354
- **Mailing address:** 10401 E KINGS HWY, SHREVEPORT, LA 71115-3227
- **Mailing address phone:** (318) 588-0880
- **Mailing address fax:** (318) 562-6354

## Taxonomy

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

## Other

- **Enumeration date:** 12/21/2006
- **Last updated:** 09/04/2024