Individual
DR. ROAN L FLENNIKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4577
(318) 798-4672
Mailing address
1455 E BERT KOUNS LOOP, SHREVEPORT, LA 71105-5634
(318) 798-4488
(318) 798-4672
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
017132
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053315846
GROUP NPI NUMBER
LA
01
—
110091280
RAILROAD MEDICARE NUMBER
LA
05
—
1358070
—
LA
Enumeration date
06/09/2005
Last updated
12/11/2020
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