Individual
MR. MYRON B DOUGLAS SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
406 BRUSHY BAYOU BLVD, SHREVEPORT, LA 71106-6900
(318) 470-3585
Mailing address
406 BRUSHY BAYOU BLVD, SHREVEPORT, LA 71106-6900
(318) 470-3585
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
—
LA
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
LA
Other
Enumeration date
07/20/2023
Last updated
07/20/2023
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