Individual
DR. EDWARD GARY CHUMLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2120 BERT KOUNS INDUSTRIAL LOOP, STE. E, SHREVEPORT, LA 71118-3351
(318) 688-3350
(318) 688-3655
Mailing address
2120 BERT KOUNS INDUSTRIAL LOOP, STE. E, SHREVEPORT, LA 71118-3351
(318) 688-3350
(318) 688-3655
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3665
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1836656
—
LA
01
—
455678
UNITED CONCORDIA INS.
—
01
—
C8303
BLUE CROSS/BLUE SHIELD LA
LA
Enumeration date
11/01/2006
Last updated
07/08/2007
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