Individual
MR. MARK DOUGLAS GANEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
310 W MISSISSIPPI AVE, RUSTON, LA 71270-4202
(318) 513-1212
Mailing address
1705 W KENTUCKY AVE, RUSTON, LA 71270-9582
(318) 355-1373
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
312368
LA
363A00000X
Physician Assistant
PA09803
TX
Other
Enumeration date
02/13/2012
Last updated
09/10/2021
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