Organization
INJURYMD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL DAVID HUCKABEE (COO)
(318) 751-9100
Entity
Organization
Contact information
Practice address
1715 MARYCREST AVE STE 200, SHREVEPORT, LA 71101-5074
(318) 751-9100
(318) 751-9101
Mailing address
135 HOLLI RD, BENTON, LA 71006-6700
(318) 751-9100
(318) 751-9101
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD.017817
STATE LICENSE
LA
Enumeration date
03/19/2019
Last updated
07/29/2019
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