Individual
DONALD GENE MACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1799 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5561
(318) 797-9000
(318) 797-9250
Mailing address
1799 E BERT KOUNS INDUSTRIAL LOOP, SHREVEPORT, LA 71105-5561
(318) 797-9000
(318) 797-9250
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
018958
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1393304
—
LA
Enumeration date
11/30/2006
Last updated
12/17/2007
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